老年男性2型糖尿病急性脑梗死患者血清基质金属蛋白酶-2,3,9的动态变化及临床意义

Dynamic changes and clinical significance of matrix metalloproteinase-2,3,9 in aged male patients with acute cerebral infarction and type 2 diabetes mellitus

目的研究合并2型糖尿病的老年男性急性脑梗死患者血清基质金属蛋白酶-2(MMP-2)、MMP-3、MMP-9水平的动态变化和临床意义。方法将急性脑梗死患者分为糖尿病脑梗死组和非糖尿病脑梗死组。对照者分为糖尿病对照组和健康对照组。ELISA法检测急性脑梗死后24 h、48 h、3 d、5 d和14 d血清MMP-2,3,9水平。比较两个脑梗死组血清MMP-2,3,9水平,分析急性脑梗死后24 h血清MMP-2,3,9水平与糖化血红蛋白(HbA1c)、空腹血糖(FBG)、甘油三酯(TG)、总胆固醇(CH)、临床神经功能缺损程度评分(CNFDS)及CNFDS的预后总积分的相关性。结果糖尿病脑梗死组血清MMP-2,3,9水平在各时间点均显著高于非糖尿病脑梗死组(均P<0.05)。糖尿病脑梗死组血清MMP-2,3,9达峰值的时间均早于非糖尿病脑梗死组。第14 d非糖尿病脑梗死组血清MMP-2,3,9均降至基础水平,而糖尿病脑梗死组血清MMP-2,3,9仍高于基础水平。非糖尿病脑梗死组CNFDS预后总积分显著高于糖尿病脑梗死组(P=0.000)。相关分析显示急性脑梗死后24 h血清MMP-2,3,9水平与HbA1c均成正相关(r=0.132,r=0.205,r=0.352;均P<0.05),与CNFDS的预后总积分均成负相关(r=-0.226,r=-0.496,r=-0.571;均P<0.05),MMP-2,3,9与CNFDS、FBG、TG、CH均无明显的相关性(均P>0.05)。结论 2型糖尿病增加急性脑梗死患者血清MMP-2,3,9的表达,影响神经功能的恢复。

Objective To explore the dynamic changes and clinical significance of matrix metalloproteinase（ MMP）-2,-3,-9 in aged male patients with acute cerebral infarction（ ACI） and type 2 diabetes mellitus（T2DM）.Methods ACI patients were divided into CI patients with T2DM group（ CTG） and CI patients without T2DM group（ CNTG）. Controls were divided into T2DM control group（TCG） and health check-up group（ HCG）. ELISA was used to measure the levels of serum MMP-2,-3 and-9 at 24 h,48 h,3 d,5 d and 14 d after onset. The levels of serum MMP-2,-3 and -9 on different time points in two cerebral infarction groups were compared. The correlations of serum MMP-2,-3,-9 with haemoglobin A1c（ HbA1c）,fasting blood-glucose（ FBG）,triglyceride（ TG） and cholesterol（ CH）,clinical neurological function deficit score（ CNFDS） and prognosis were analyzed. Results At all the detected time points,the levels of serum MMP-2,-3 and-9 in CTG were significantly higher than those in CNTG（ all P〈0. 05）. The levels of serum MMP-2,-3 and-9 in CTG reached the peak earlier than CNTG. Otherwise,the levels of serum MMP-2,-3 and-9 in CNTG at 14 d decreased to basal levels,whereas the levels of serum MMP-2,-3 and-9 in CTG were still higher than the base level. Prognostic score of CNTG was significantly higher when compared to CTG（ P = 0. 000）. The analysis of relationship showed that the levels of serum MMP-2,-3 and-9 at 24 h after onset were positively correlated with the levels of HbA1c（ r = 0. 132,r = 0. 205,r = 0. 352; all P〈0. 05） and negatively correlated with prognostic score of CNTG（ r =- 0. 226,r =- 0. 496,r =- 0. 571; all P〈0. 05）. No obvious relationships were observed between the levels of MMP-2,-3,-9 and CNFDS,FBG,TG and CH（ all P〉0. 05）. Conclusion T2DM increases the expressions of serum MMP-2,-3 and-9 in the patients with ACI and influences the recovery of neurological symptoms.