急性脑梗死合并阻塞性睡眠呼吸暂停低通气综合征患者颈动脉内-中膜厚度及血清基质金属蛋白酶9水平变化

Changes of Carotid Intima- media Thickness and Serum MMP- 9 in Acute Cerebral Infarction Combined with Obstructive Sleep Apnea- hypopnea Syndrome Patients

目的探讨急性脑梗死(ACI)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者颈动脉内-中膜厚度(IMT)及血清基质金属蛋白酶9(MMP-9)水平的变化。方法选取2012年1月—2013年6月河北大学附属医院住院的ACI患者,均符合第四届全国脑血管病学术会议制订的脑梗死的诊断标准,行多导睡眠图(PSG)确诊合并OSAHS的患者36例为ACI合并OSAHS组,根据AHI分为轻度组10例、中度组13例、重度组13例;另选择同时期ACI患者经PSG排除OSAHS患者39例为单纯ACI组。患者均行彩色多普勒超声检查,记录颈动脉IMT,酶联免疫吸附试验(ELISA)法检测血清MMP-9水平。结果 ACI合并OSAHS组患者颈动脉IMT及血清MMP-9水平均高于单纯ACI组(P<0.05)。ACI合并OSAHS组患者颈动脉IMT与血清MMP-9呈正相关(r=0.582,P=0.000)。ACI合并OSAHS患者轻度组、中度组、重度组患者颈动脉IMT及血清MMP-9水平比较,差异有统计学意义(P<0.05);其中中度组和重度组颈动脉IMT及血清MMP-9水平高于轻度组(P<0.05)。结论 ACI合并OSAHS患者颈动脉IMT及血清MMP-9水平升高,中、重度组患者升高更明显,且颈动脉IMT与血清MMP-9水平呈正相关,OSAHS可能通过炎症途径促使ACI的发生。

Objective To investigate the changes of carotid intima-media thickness（ IMT）and serum MMP-9 in a-cute cerebral infarction（ACI）combined with obstructive sleep apnea-hypopnea syndrome（OSAHS）. Methods ACI patients admitted to the Affiliated Hospital of Hebei University from January 2012 to June 2013 were selected. All the patients met the diag-nostic criteria for infarction established in the Fourth National Cerebrovascular Disease Seminar. 36 cases were confirmed with OSAHS by PSG,and were then included in the ACI combined with OSAHS group. According to the severity of AHI,the patients were divided into mild group（10 cases）,moderate group（13 cases）and severe group（13 cases）. Another 39 ACI patients without OSAHS were included in the ACI alone group. All cases were given color Doppler ultrasound to record IMT,and ELISA was used to detect the serum MMP-9 level. Results The IMT and serum MMP-9 levels of ACI patients combined with OSAHS were both higher than those of patients with ACI alone（ P〈0. 05 ） . The IMT was positively correlated with serum MMP-9 in ACI patients combined with OSAHS（r=0. 582,P=0. 000）. The IMT and serum MMP-9 levels of the mild,moderate and severe groups of ACI patients combined with OSAHS showed statistically significant differences（P〈0. 05）. The IMT and serum MMP-9 levels of the moderate and severe groups were higher than the mild group（P〈0. 05）. Conclusion The IMT and ser-um MMP-9 levels in ACI patients combined with OSAHS are higher,especially in moderate and severe groups. The IMT is posi-tively correlated with serum MMP-9 level,and OSAHS may cause the occurrence of ACI in the way of inflammation.