基质金属蛋白酶9和颈动脉内膜剥脱术中微栓子脱落的相关性

Correlation of Matrix Metalloproteinases-9 with Microemboli Shedding in Carotid Endarterectomy

目的研究基质金属蛋白酶9(MMP-9)在颈动脉内膜剥脱术(CEA)术前、术中和术后的表达变化及其临床预警作用。方法前瞻性纳入2012年2至9月在北京协和医院血管外科行CEA治疗的颈动脉狭窄患者,根据术中经颅多普勒超声是否监测到栓子脱落将患者分为栓子组和无栓子组,使用酶联免疫吸附法和明胶酶谱法检测CEA术前、颈动脉开放前、开放后30 min、术后12 h血清MMP-9浓度和活性。结果共纳入40例患者,栓子组8例、非栓子组32例。栓子组术后12 h MMP-9浓度显著高于术前[(904.27±369.47)ng/ml比(333.88±126.32)ng/ml,t=4.132,P=0.001)],无栓子组术前、术后12 h MMP-9表达差异无统计学意义[(375.83±194.36)ng/ml比(472.74±271.21)ng/ml,t=-1.643,P=0.081)]。明胶酶谱结果同样显示,栓子组术后12 h MMP-9活性较术前显著升高。结论 CEA术后发生微栓子脱落者,其术后12 h血清MMP-9水平较术前显著升高,提示MMP-9可能为CEA术后脑缺血性损伤的潜在生化学标志物。

Objective To investigate the change of serum matrix metalloproteinases-9(MMP-9)expression before,during,and after carotid endarterectomy(CEA)and to investigate the prognostic role of MMP-9.Methods Forty carotid stenosis patients who underwent CEA in the Department of Vascular Surgery,Peking Union Medical College Hospital from February to September 2012 were enrolled in this study.Based on the findings of transcranial doppler monitoring,patients were divided into embolic-positive group and emboli-negative group.Serum samples were obtained from 40 consecutive patients undergoing CEA before operation(pre-op),before de-clamping,30 minutes after de-clamping,and 12 hours after operation(12-h post-op).MMP-9 expression was quantified using enzyme-linked immunosorbent assay and gelatin zymography.Student’s t-test and chi-square test were used to compare the differences between these two groups.Results Of these 40 patients,microemboli were detected in 8 patients.The 12-h post-op MMP-9 level was significantly higher than the pre-op level in the emboli-positive group[(904.27±369.47)ng/ml vs.(333.88±126.32)ng/ml,t=4.132,P=0.001].However,there was no difference between pre-op and 12-h post-op MMP-9 levels in the emboli-negative group[(375.83±194.36)ng/ml vs.(472.74±271.21)ng/ml,t=-1.643,P=0.081].Gelatin zymography also showed higher MMP-9 activity in the emboli-positive group than in the emboli-negative group.Conclusion Serum MMP-9 concentration remarkably increases 12 hours after CEA in patients with microemboli shedding,suggesting MMP-9 may be a potential biomarker for CEA-related cerebral ischemic injury.