显微外科手术治疗对颅内动脉瘤患者预后及血浆MMP和TIMP表达的影响

Effect of microsurgery on prognosis and expression of plasma MMP and TIMP in patients with intracranial aneurysms

目的探讨显微外科手术治疗对颅内动脉瘤患者预后及血浆基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)和基质金属蛋白酶抑制剂-1(TIMP-1)表达的影响。方法选取2016年1月至2017年1月间自贡市第一人民医院收治的68例行显微外科手术治疗的颅内动脉瘤老年患者为观察组,分别于术前和出院当日清晨采集空腹静脉血,采用酶联免疫吸附法(ELISA)检测MMP-2、MMP-9和TIMP-1含量,比较手术前后变化情况。另选取同期健康体检者24例为对照组,检测其血浆MMP-2、MMP-9及TIMP-1表达,并与观察组患者手术前后比较。对所有患者进行随访,采用格拉斯哥预后评分(GOS)评价预后情况。结果观察组患者GOS评分5分52例,4分12例,3分3例,2分1例,术前动脉瘤破裂出血1次的患者预后优于出血2次的患者,差异有统计学意义(P<0.05)。术前,观察组患者血浆MMP-2、MMP-9及TIMP-1均明显高于对照组,术后MMP-2和MMP-9表达较术前均明显降低,差异均有统计学意义(均P<0.05),与对照组比较,差异无统计学意义(P>0.05);观察组患者术后血浆TIMP-1表达与术前比较,差异无统计学意义(P>0.05)。结论颅内动脉瘤患者早确诊及选择实施合适的手术时机和方案,可有效改善患者预后,降低手术死亡率。血浆MMP和TIMP表达水平的检测,可能成为早期诊断重要的辅助手段。

Objective To observe the effect of microsurgical treatment on the prognosis and the expression of plasma matrix metalloproteinase-2（ MMP-2）,matrix metalloproteinase-9（ MMP-9） and matrix metalloproteinase inhibitor（ TIMP-1） in patients with intracranial arterial aneurysm. Methods Sixty-eight elderly patients with intracranial aneurysms undergoing microsurgery at First People＇s Hospital of Zigong from January 2016 to January 2017 were selected as the study subjects. The peripheral venous blood was collected from these patients in fasting state in the morning on the day before operation and on discharge. Enzyme linked immunosorbent assay（ ELISA） was used to detect the contents of MMP-2,MMP-9 and TIMP-1,and the changes in the content of MMP-2,MMP-9 and TIMP-1 were compared between the two groups. Another24 healthy people who had physical examination at the hospital were selected as the control group and their plasma levels of MMP-2,MMP-9 and TIMP-1 were detected and compared with those of the observation group. All of them were followed-up and GOS scoring system was used to evaluate the prognosis. Results GOS score was 5 in 52 patients,4 in 12 patients,3 in 3 patients,2 in 1 patient,and the prognosis of patients with 1 ruptured aneurysm bleeding before operation was better than that of 2 bleedings（ P〈0. 05）.Plasma levels of MMP-2,MMP-9 and TIMP-1 were significantly higher in the observation group than those in the control group（ P〈0. 05） before the surgery. The expressions of MMP-2 and MMP-9 significantly decreased after the operation（ P〈0. 05） but there was no significant difference between two groups（ P〈0. 05）. There was no significant difference in the expression of plasma TIMP-1 in the observation group between before and after operation（ P〉0. 05）. Conclusion The early diagnosis of intracranial aneurysms and the selection,timing and implementation of appropriate surgical protocols according to the specific conditions of the patients can effectively improve the prognosis and reduce the mortality. At the same time,the detection of the levels of MMP and TIMP in patients with intracranial aneurysms may become an important auxiliary method for early diagnosis.