急性脑出血患者血清MIP-1α、CCR5、MMP-9水平动态变化及其与神经功能缺损程度和预后的相关性

Dynamic changes of serum MIP-1α,CCR 5 and MMP-9 in patients with acute cerebral hemorrhage and their correlations with the degree of neurological deficit and prognosis

目的观察急性脑出血患者血清巨噬细胞趋化蛋白-1α(MIP-1α)、趋化因子受体5(CCR5)、基质金属蛋白酶-9(MMP-9)水平的动态变化,并分析血清MIP-1α、CCR5、MMP-9表达水平与脑出血患者神经功能缺损程度和预后的相关性。方法急性脑出血患者92例(脑出血组),均接受常规西医治疗4周;另选取同期进行体检的健康人群120例纳入健康组。脑出血组患者于入院24 h、治疗3 d、治疗7 d、治疗14 d、治疗4周、出院1个月、出院2个月、出院3个月、出院4个月时,健康组受检者于体检时,抽取静脉血,采用ELISA法检测血清MIP-1α、CCR5、MMP-9。急性脑出血患者于入院24 h、治疗3 d、治疗7 d、治疗14 d、治疗4周时,采用NIHSS评分量表评估患者神经功能缺损程度;于出院1个月、出院2个月、出院3个月、出院4个月时,采用改良Rankin量表评估患者预后情况;采用Pearson相关分析法分析血清MIP-1α、CCR5、MMP-9表达水平与急性脑出血患者神经功能缺损程度和预后的相关性。结果脑出血组患者入院24 h时血清MIP-1α、CCR5、MMP-9表达水平高于健康组(P均<0.05)。随着治疗的时间延长,急性脑出血患者血清MIP-1α、CCR5、MMP-9表达水平逐渐下降,NIHSS评分也逐渐降低(P均<0.05)。急性脑出血患者治疗期间血清MIP-1α、CCR5、MMP-9表达水平与NIHSS评分呈正相关(r值分别为0.969、0.992、0.911,P均<0.05)。出院后,随着康复时间的延长,急性脑出血患者血清MIP-1α、CCR5、MMP-9表达水平逐渐下降,改良Rankin量表评分逐渐升高(P均<0.05)。急性脑出血患者出院后血清MIP-1α、CCR5、MMP-9表达水平与改良Rankin量表评分正相关(r值分别是0.973、0.986、0.972,P均<0.05)。结论急性脑出血患者血清MIP-1α、CCR5、MMP-9表达水平升高,经治疗后呈动态下降趋势;治疗期间,血清MIP-1α、CCR5、MMP-9表达水平与急性脑出血患者神经功能缺损程度同步下降;出院后,血清MIP-1α、CCR5、MMP-9表达水平与急性脑出血患者预后正相关。

Objective To observe the dynamic changes of serum macrophage inflammatory protein-1α(MIP-1α),chemokine receptor 5(CCR5),and matrix metalloproteinase-9(MMP-9)in patients with acute cerebral hemorrhage,and to analyze the correlation between serum MIP-1α,CCR5,MMP-9 expression levels and the degree of neurological deficit and prognosis of patients with cerebral hemorrhage.Methods Ninety-two patients with acute cerebral hemorrhage(cerebral hemorrhage group)received conventional western medicine treatment for 4 weeks,and another 120 healthy people who underwent physical examination during the same period were selected and included in the healthy group.The serum MIP-1α,CCR5 and MMP-9 were detected by ELISA in the cerebral hemorrhage group at 24 h after admission,3 days of treatment,7 days of treatment,14 days of treatment,4 weeks of treatment,1 month after discharge,2 months after discharge,3 months after discharge,and 4 months after discharge.During physical examination,venous blood was drawn from the healthy people in the healthy group,and serum MIP-1α,CCR5 and MMP-9 were detected by ELISA.The degree of neurological deficit of patients with acute cerebral hemorrhage was evaluated by NIHSS score at 24 h after admission,3 days of treatment,7 days of treatment,14 days of treatment,and 4 weeks of treatment.At 1,2,3,and 4 months after discharge,the modified Rankin scale was used to evaluate the prognosis of patients;Pearson correlation analysis was used to analyze the relationships between the expression levels of serum MIP-1α,CCR5 and MMP-9 and the degree of neurological deficit and prognosis of patients with acute cerebral hemorrhage.Results The expression levels of serum MIP-1α,CCR5,and MMP-9 in the cerebral hemorrhage group were higher than those in the healthy group at 24 h after admission(all P<0.05).Over the course of treatment,the expression levels of serum MIP-1α,CCR5 and MMP-9 in patients with acute cerebral hemorrhage gradually decreased,and the NIHSS score also decreased gradually(all P<0.05).The expression levels of serum MIP-1α,CCR5,and MMP-9 in patients with acute cerebral hemorrhage during treatment were positively correlated with the NIHSS score(r values were 0.969,0.992,and 0.911,all P<0.05).After discharge,over the recovery time,the expression levels of serum MIP-1α,CCR5 and MMP-9 in patients with acute cerebral hemorrhage gradually decreased,and the score of modified Rankin scale gradually increased(all P<0.05).The expression levels of serum MIP-1α,CCR5,and MMP-9 in patients with acute cerebral hemorrhage after discharge were positively correlated with the modified Rankin scale score(r values were 0.973,0.986,and 0.972,all P<0.05).Conclusion The expression levels of serum MIP-1α,CCR5,and MMP-9 in patients with acute cerebral hemorrhage increased,which showed a dynamic downward trend after treatment.During treatment,the expression levels of serum MIP-1α,CCR5 and MMP-9 decreased synchronously with the degree of neurological deficit in patients with acute cerebral hemorrhage.After discharge,the expression levels of serum MIP-1α,CCR5 and MMP-9 were positively correlated with the prognosis of patients with acute cerebral hemorrhage.