急性重症颅脑损伤患者血清MMP-9和S100B的水平变化及临床意义

Change of MMP-9 and S100B levels in serum of acute severe craniocerebral injury patients

目的探讨急性重症颅脑损伤患者血清基质金属蛋白酶9(MMP-9)和S100B的水平变化规律以及对临床预后的影响。方法选择80例急性重症颅脑损伤患者进行格拉斯哥昏迷评分(GCS)、急性生理学与慢性健康状况Ⅱ评分(APACHEⅡ评分)和格拉斯哥预后分级(GOS)评分,并选择80例同期住院的轻中度颅脑损伤患者和10例正常人群作为对照,并在入院第1、2、3、4天用酶联免疫吸附法(ELISA)测定血清中MMP-9和S100B水平,并分析其与颅脑损伤患者预后和颅脑CT影像学特点的相关性。结果急性重症颅脑损伤患者血清MMP-9和S100B水平在入院第1、2、3、4天较轻中度颅脑损伤组和正常人群皆高,差异有统计学意义(P<0.01)。MMP-9和S100B表达越高,GOS分级评分越低。当颅脑CT显示中线移位≥1 cm、环池消失、脑挫裂伤和并颅内血肿时,患者MMP-9和S100B的水平均明显高于环池正常或受压、单纯硬膜外血肿或局限性脑挫裂伤患者,且具有明显差异(P<0.05)。结论 MMP-9和S100B水平测定可作为早期判断急性重症颅脑损伤患者的病情严重程度和预后的重要指标。

[Objective ] To investigate the change rule of matrix metalloproteinase 9 （MMP-9） and protein S100B in acute severe craniocerebral injury patients, and the impact on the clinical outcome. [Methods] 80 patients were scored with Glasgow coma scale （GCS）, acute physiology and chronic health evaluation Ⅱ score （APACHE Ⅱ score） and Glasgow outcome score （GOS）; and 80 at the same period hospitalized mild-to-mod- erate craniocerebral injury patients and I0 normal people were chosen as control. The MMP-9 and SIOOB level in plasma of all patients were analyzed by enzyme-linked immunosorbent assay （ELISA） at the day 1, 2, 3, 4 after hospitalized, and its relation to the outcome and cerebral CT imaging features were analyzed. [Re- sults] The level of MMP-9 and S100B in plasma of acute severe craniocerebral injury patients in the day 1, 2, 3, 4 after hospitalized were significant differences to mild-to-moderate craniocerebral injury patients and normal people （P〈0.01）. The higher expression of MMP-9 and S100B, the lower GOS score it gets. When the brain CT showed midline shift ≥ 1 cm, ring pools disappear, and cerebral contusion and intracranial hematoma, MMP-9 and S100B in patients were significantly higher than normal ambient cistern or pressure, epidural hematoma, or limitations patients with cerebral contusion （P 〈0.05）. [Conclusion] The MMP-9 and S100B protein assay can be used as an important indicator in early judgment in patients with acute severe craniocerehral injury severity and prognosis.