血清MMP-9和BDNF在急性脑梗死患者中的表达水平变化及预后临床研究

Clinical study on the changes of serum MMP-9 and BDNF expression levels and prognosis in patients with acute cerebral infarction

目的研究血清基质金属蛋白酶-9(MMP-9)和脑源性神经营养因子(BDNF)在急性脑梗死(ACI)患者中的表达水平变化和与预后的相关性。方法选取2019年1月—6月在广东省肇庆市第一人民医院就诊,确诊为ACI并完成3个月随访的患者42例为研究组,选择同期体检健康人群40名为对照组。研究组检测入院第1天(T1)、第2天(T2)及第5天(T5)的血清MMP-9和BDNF水平,对照组检测体检时血清MMP-9和BDNF水平。研究组进行3个月随访研究。按预后情况将研究组分为预后良好组24例和预后不良组18例。比较研究组与对照组、预后良好组与预后不良组的MMP-9和BDNF水平。结果T1时间点,研究组血清MMP-9和BDNF水平均高于对照组,差异均有统计学意义(均P<0.05)。按预后进行分组,对预后良好组与预后不良组MMP-9水平进行重复测量方差分析,两组组间和交互作用比较,差异均有统计学意义(均P<0.05),时间点比较,差异无统计学意义(P>0.05)。进一步分析,T5时间点,预后不良组MMP-9水平高于预后良好组,差异有统计学意义(P<0.05)。对两组BDNF水平进行分析,两组时间点和交互作用比较,差异均有统计学意义(均P<0.05),组间比较,差异无统计学意义(P>0.05)。进一步分析,预后良好组T2时间点BDNF水平高于T1时间点,T5时间点BDNF水平高于T2时间点,差异均有统计学意义(均P<0.05);预后不良组T2时间点和T5时间点BDNF水平均低于T1时间点,差异均有统计学意义(均P<0.05)。结论MMP-9和BDNF的变化与ACI患者预后密切相关,在发病最初期,BDNF水平高提示预后可能不佳,在治疗数日后,MMP-9高水平、BDNF水平降低提示预后不佳。

Objective To study the changes of serum matrix metalloproteinase-9(MMP-9)and brain-derived neurotrophic factor(BDNF)expression levels in patients with acute cerebral infarction(ACI)and their correlation with prognosis.Methods Forty-two patients who were diagnosed with ACI and completed the three-month follow-up at the First People’s Hospital of Zhaoqing,Guangdong Province from January to June 2019 were selected as the study group,and 40 healthy people with physical examination during the same period were selected as the control group.The serum MMP-9 and BDNF levels in the study group on the first day(T1),the second day(T2)and the fifth day(T5)were detected,and the serum MMP-9 and BDNF levels in the control group were detected during physical examination.The study group was followed up for three months.According to the prognosis,the study group was divided into good prognosis group(24 cases)and poor prognosis group(18 cases).The levels of MMP-9 and BDNF were compared between the study group and the control group,the good prognosis group and the poor prognosis group.Results At T1 time point,the serum MMP-9 and BDNF levels of the study group were higher than those of the control group,the differences were statistically significant(all P<0.05).According to the prognosis,the MMP-9 levels in the good prognosis group and the poor prognosis group were analyzed by repeated measures analysis of variance.Comparison and interaction between the two groups showed statistically significant differences(all P<0.05),while time point comparison showed no statistically significant difference(P>0.05).Further analysis showed that the level of MMP-9 in the poor prognosis group was higher than that in the good prognosis group at T5 time point,the difference was statistically significant(P<0.05).The BDNF levels of the two groups were analyzed,comparison of time point and interaction between the two groups showed statistically significant differences(all P<0.05),while there was no statistically significant difference between the two groups(P>0.05).Further analysis showed that the BDNF level at T2 time point was higher than that at T1 time point in the good prognosis group,and the BDNF level at T5 time point was higher than that at T2 time point,the differences were statistically significant(all P<0.05).The BDNF level at T2 time point and T5 time point in the poor prognosis group was lower than that at T1 time point,the differences were statistically significant(all P<0.05).Conclusion The changes of MMP-9 and BDNF are closely related to the prognosis of ACI patients.In the initial stage of onset,a high level of BDNF may indicate a poor prognosis.After several days of treatment,a high level of MMP-9 and a decrease in BDNF level may indicate a poor prognosis.