急性脑梗死患者血清MMP-9、TIMP-1水平与认知障碍的相关性

Correlations Between Serum MMP-9 and TIMP-1 Levels and Cognitive Impairment in Patients with Acute Cerebral Infarction

目的探讨急性脑梗死患者血清基质金属蛋白酶-9(MMP-9)、金属蛋白酶组织抑制因子-1(TIMP-1)水平与认知障碍的相关性。方法选取2018年10月至2019年10月新乡医学院第一附属医院神经内科收治的180例急性脑梗死患者为研究对象。采用蒙特利尔认知评估基础量表(MoCA-B)评估患者认知,根据入院1周时MoCA-B评分,分为非认知障碍组(对照组)和认知障碍组(观察组)。对照组84例,观察组96例,将观察组重度认知障碍患者纳入观察组A(39例),将轻度或中度认知障碍患者纳入观察组B(57例)。采用酶联免疫吸附法检测患者血清MMP-9、TIMP-1水平。采用Spearman秩相关分析血清MMP-9、TIMP-1水平与认知功能的相关性。采用受试者工作特征(ROC)曲线评估患者血清MMP-9、TIMP-1水平预测脑梗死后认知障碍的价值。结果入院时观察组血清MMP-9水平高于对照组,血清TIMP-1水平低于对照组,入院1周时MoCA-B评分低于对照组(P<0.05)。治疗3个月时,两组血清MMP-9水平均较入院时降低,观察组血清TIMP-1水平较入院时升高,MoCA-B评分较入院1周时升高,且观察组血清MMP-9水平高于对照组,血清TIMP-1水平及MoCA-B评分均低于对照组(P<0.05)。入院时及治疗3个月时,观察组A血清MMP-9水平均高于观察组B,血清TIMP-1水平均低于观察组B(P<0.05)。观察组A、观察组B血清MMP-9水平差值、TIMP-1水平差值比较,差异有统计学意义(P<0.05)。治疗3个月时,观察组A、观察组B血清MMP-9水平均较入院时降低,TIMP-1水平均较入院时升高(P<0.05)。入院1周时,观察组MoCA-B评分与入院时血清MMP-9水平呈负相关(r=-0.681,P<0.05),与入院时血清TIMP-1水平呈正相关(r=0.501,P<0.05)。治疗3个月时,观察组MoCA-B评分与血清MMP-9水平呈负相关(r=-0.548,P<0.05),与血清TIMP-1水平呈正相关(r=0.473,P<0.05)。ROC曲线结果显示,入院时血清MMP-9及TIMP-1水平预测认知障碍发生的曲线下面积分别为0.834(95%CI:0.743~0.926,P<0.05)和0.746(95%CI:0.646~0.846,P<0.05),治疗3个月时血清MMP-9及TIMP-1水平预测认知障碍发生的曲线下面积分别为0.795(95%CI:0.696~0.895,P<0.05)和0.880(95%CI:0.810~0.951,P<0.05)。结论急性脑梗死认知障碍患者血清MMP-9水平升高,TIMP-1水平下降,且与认知障碍程度相关。血清MMP-9、TIMP-1水平在一定程度上可以预测急性脑梗死患者认知障碍的发生与预后。

Objective To explore the correlations between serum matrix metalloproteinase-9(MMP-9)and tissue inhibitor of metalloproteinase-1(TIMP-1)levels and cognitive impairment in patients with acute cerebral infarction.Methods The patients with acute cerebral infarction admitted to the Department of Neurology in the First Affiliated Hospital of Xinxiang Medical University from October 2018 to October 2019 were selected as the research objects.The Montreal cognitive assessment-basic(MoCA-B)was used to evaluate patients’cognition.According to the MoCA-B score at 1 week after admission,they were divided into non-cognitive impairment group(control group)and cognitive impairment group(observation group).There were 84 cases in control group and 96 cases in observation group.The patients with severe cognitive impairment in observation group were included in observation group A(39 cases),and patients with mild or moderate cognitive impairment were included in observation group B(57 cases).Enzyme-linked immunosorbent assay was used to detect the serum MMP-9 and TIMP-1 levels.Spearman rank correlation was used to analyze the correlations between serum MMP-9,TIMP-1 levels and cognitive function.The receiver operating characteristic(ROC)curve was used to evaluate the value of serum MMP-9 and TIMP-1 levels in predicting cognitive impairment after cerebral infarction.Results On admission,the serum MMP-9 level in observation group was higher than that in control group,and the serum TIMP-1 level was lower than that in control group,and the MoCA-B score in observation group was lower than that in control group at 1 week after admission(P<0.05).At 3 months of treatment,the serum MMP-9 levels in the two groups were both lower than those on admission,and the serum TIMP-1 level in observation group was higher than that on admission,and MoCA-B score in observation group was higher than that at 1 week after admission,while the serum MMP-9 level in observation group was higher than that in control group,and the serum TIMP-1 level and MoCA-B score were both lower than those in control group(P<0.05).On admission and at 3 months of treatment,the serum MMP-9 levels in observation group A were both higher than those in observation group B,and the serum TIMP-1 levels were both lower than those in observation group B(P<0.05).There were statistical differences in the differences of serum MMP-9 and TIMP-1 levels between observation group A and observation group B(P<0.05).At 3 months of treatment,the serum MMP-9 levels in observation group A and observation group B were both lower than those on admission,and the serum TIMP-1 levels were both higher than those on admission(P<0.05).At 1 week after admission,the MoCA-B score in observation group was negatively correlated with the serum MMP-9 level on admission(r=-0.681,P<0.05),and it was positively correlated with the serum TIMP-1 level on admission(r=0.501,P<0.05).At 3 months of treatment,the MoCA-B score in observation group was negatively correlated with serum MMP-9 level(r=-0.548,P<0.05),and it was positively correlated with the serum TIMP-1 level(r=0.473,P<0.05).The results of ROC curve showed that the areas under the curve of serum MMP-9 and TIMP-1 levels on admission predicting cognitive impairment were 0.834(95%CI:0.743 to 0.926,P<0.05)and 0.746(95%CI:0.646 to 0.846,P<0.05),respectively.The areas under the curve of serum MMP-9 and TIMP-1 levels at 3 months of treatment predicting cognitive impairment were 0.795(95%CI:0.696 to 0.895,P<0.05)and 0.880(95%CI:0.810 to 0.951,P<0.05),respectively.Conclusion The serum MMP-9 level in patients with cognitive impairment after acute cerebral infarction is increased,and the serum TIMP-1 level is decreased.Meanwhile,they are related to the degree of cognitive impairment.The serum MMP-9 and TIMP-1 levels can predict the occurrence and prognosis of cognitive impairment in patients with acute cerebral infarction to some extent.