急性脑出血后血肿腔引流液及外周血THR、MMP-9与脑水肿、神经功能损伤的相关性

Correlation of Dynamic Changes of Thrombin and MMP-9 in Hematoma Cavity Drainage Fluid and Peripheral Blood with Cerebral Edema and Neurological Damage after Acute Cerebral Hemorrhage

目的检测急性脑出血后血肿腔引流液及外周血中凝血酶(THR)、基质金属蛋白酶-9(MMP-9)动态变化,观察其与患者脑水肿、神经功能损伤的关系。方法选择2017年1月~2019年6月我院收治的75例行血肿清除术或血肿钻孔引流术的急性脑出血患者为对象,分别于术后第1、3、7、14天采集外周血及血肿腔引流液,采用酶联免疫吸附法检测外周血及血肿腔引流液中THR、MMP-9表达水平,并测定各时点头颅CT所示脑水肿比值。采用美国国立卫生研究院卒中量表(NIHSS)评估患者术后第1、3、7、14天神经功能损伤情况,判断急性脑出血后血肿腔引流液及外周血中THR、MMP-9表达水平与脑水肿比值、NIHSS评分的相关性。结果急性脑出血患者术后3、7天血肿腔引流液及外周血中THR、脑水肿比值、MMP-9高于术后1天(P<0.05),术后14天血肿腔引流液及外周血中THR、脑水肿比值、MMP-9均低于术后1、3、7天(P<0.05)。术后3、7天血肿腔引流液及外周血中MMP-9高于术后1天(P<0.05),术后7天血肿腔引流液及外周血中MMP-9低于术后3天(P<0.05),急性脑出血患者术后3天NIHSS评分高于术后1天(P<0.05),术后7天NIHSS评分低于术后1、3天(P<0.05),术后14天NIHSS评分低于术后1、3、7天(P<0.05),急性脑出血后血肿腔引流液及外周血中THR、MMP-9与脑水肿比值、NIHSS评分均呈正相关(P<0.05)。结论脑出血后血肿腔引流液及外周血中THR、MMP-9动态变化与脑水肿、神经功能损伤密切相关,临床应引起足够重视。

Objective To detect the dynamic changes of thrombin(THR)and matrix metalloproteinase-9(MMP-9)in the drainage fluid of hematoma cavity and peripheral blood after acute cerebral hemorrhage,and to observe its relationship with cerebral edema and neurological damage.Methods A total of 75 patients with acute cerebral hemorrhage who underwent hematoma removal or hematoma drilling drainage were treated in our hospital from January 2017 to June 2019.The peripheral blood was collected on the 1st,3rd,7th,and 14th days after surgery.Blood and hematoma cavity drainage fluids were tested for the expression of THR and MMP-9 in peripheral blood and hematoma cavity drainage fluids by enzyme-linked immunosorbent assay,and the brain edema ratios as shown by skull CT at each time point were measured.The National Institutes of Health Stroke Scale(NIHSS)was used to assess the neurological impairment of patients at 1,3,7,and 14 days after surgery,and to determine the expression levels of THR and MMP-9 in hematoma drainage fluid and peripheral blood after acute cerebral hemorrhage.Correlation with cerebral edema ratio and NIHSS score.Results Patients with acute cerebral hemorrhage had higher THR,cerebral edema ratio,and MMP-9 in hematoma cavity drainage fluid and peripheral blood at 3 and 7 days after surgery(P<0.05),and hematoma drainage fluid and peripheral blood at 14 days after surgery.The THR,cerebral edema ratio and MMP-9 were all lower than those at 1,3,and 7 days after operation(P<0.05).MMP-9 in hematoma cavity drainage fluid and peripheral blood was higher at 3 and 7 days after operation(P<0.05).On the 7th day after operation,the MMP-9 in drainage fluid and peripheral blood of hematomas cavity was lower than that of 3 days after operation(P<0.05).The NIHSS score of patients with acute cerebral hemorrhage on the 3rd day after operation was higher than that on the 1st day after operation(P<0.05).The NIHSS score at 7 days after surgery was significantly lower than that at 1 and 3 days after surgery(P<0.05),and the NIHSS score at 14 days after surgery was lower than at 1,3,and 7 days after surgery(P<0.05).After acute cerebral hemorrhage,HR and MMP-9 in hematoma cavity drainage fluid and peripheral blood were positively correlated with cerebral edema ratio and NIHSS score(P<0.05).Conclusion The dynamic changes of THR and MMP-9 in hematoma drainage fluid and peripheral blood after intracerebral hemorrhage are closely related to cerebral edema and neurological damage,which should be paid enough attention in clinic.