基质金属蛋白酶及其组织抑制剂水平与恶性大脑中动脉梗死患者死亡率的关系

Association of serum levels of matrix metalloproteinases and their tissue inhibitors with mortality in patients with malignant middle cerebral artery infarction

目的观察基质金属蛋白酶（MMPs）及其组织抑制剂水平与恶性大脑中动脉梗死患者死亡率的关系。方法以74例恶性大脑中动脉梗死患者为观察组，242例其它脑梗死患者为病例对照组，74例志愿者为健康对照组。采血检测MMP-9、MMP．10、基质金属蛋白酶组织抑制剂（TIMP）-1水平；采用问卷调查和临床检查的方式收集患者的信息，以入院后30d死亡率为观察终点指标。结果观察组的MMP-9、MMP-10和TIMP-1水平明显高于病例对照组，而病例对照组的MMP-9、MMP-10、TIMP-1水平又高于健康对照组（P〈0．05）。观察组中病死者的格拉斯哥评分明显低于存活者（P〈0．05），TNF-α、MMP-9、MMP-10和TIMP-1水平明显高于存活者（P〈0．05）。多元Logistic回归分析结果表明TNF—α、MMP-9、MMP-10和TIMP-1的水平与大脑中动脉梗死患者的30d死亡率有关，其OR值分别为1．09、1．18、1．13和1．32。结论MMP-9、MMP-10和TIMP-1水平与恶性大脑中动脉梗死患者死亡率有关，可以作为恶性大脑中动脉梗死患者预后及死亡率判断的辅助指标。

Objective To investigate the relationship between serum levels of matrix metalloprotei- nases （MMPs） and tissue inhibitors of metalloproteinases （TIMP） and the mortality in patients with malignant middle cerebral artery infarction. Methods A total of 74 patients with malignant middle cerebral ar- tery infarction （MMCAI） was assigned to research group, 74 healthy volunteers were recruited to serve as healthy controls, and 242 patients with other cerebral infarction were recruited to serve as case controls. Quality-of-life questionnaire and clinical examination were used to collect the information of participants. Endpoint was 30-day mortality. Results The research group showed higher serum levels of MMP-9, MMP- 10, and TIMP-1 relative to the ease control group, and the case control group showed higher serum levels of MMP-9, MMP-10, and TIMP-1 relative to the healthy control group （ P 〈 0. 05 ）. Compared to survivor ones, non-surviving MMCAI patients showed lower Glasgow Coma Scale score （ P 〈 0.05 ）, higher serum levels of tumor necrosis factorα （TNF-α）, MMP-9, MMP-10, and TIMP-1 （P 〈0. 05）. Multiple logistic regression analysis showed that serum levels of TNF-α, MMP-9, MMP-10, and TIMP- 1 were associated with 30-day mortality, and the OR were 1.09, 1. 18, 1.13, and 1.32, respectively. Conclusions Serum levels of MMP-9, MMP-10, and TIMP-1 levels in MMCAI patients were associated with mortality, and could be used as an auxiliary index of mortality in MMCAI patients.