脑出血患者血清基质金属蛋白酶9和金属蛋白酶组织抑制剂1水平变化及其与脑水肿的相关性

摘要

Objective To explore the levels of serum matrix metalloproteinase-9 and tissue inhibitor of metalloprpteinase-1 in patients with cerebral hemorrhage and their correlations with cerebral edema.Methods Totally 78 patients with cerebral hemorrhage (cerebral hemorrhage group) and 78 healthy subjects (control group) from April 2013 to March 2015 were enrolled.The levels of serum MMP-9 and TIMP-1 of control group and cerebral hemorrhage group within 24 h after hemorrhage and 3,5,7 and 14 d after hemorrhage were measured;CT examination was performed in cerebral hemorrhage group at above time points.The correlations between MMP-9 and TIMP-1 with edema volume were analyzed.Results The MMP-9 level in cerebral hemorrhage group within 24 h after hemorrhage and 3,5,7,14 d after hemorrhage was significantly higher than that in control group [(226 ±31),(246 ±32),(254 ±34),(240±32),(227 ±31) μg/L vs (54 ±8) μg/L] (P ＜0.05 or P ＜0.01);it reached the peak 5 d after hemorrhage and then was gradually decreased.The TIMP-1 level in cerebral hemorrhage group within 24 h after hemorrhage and 3,5,7 d after hemorrhage was significantly higher than that in control group [(176±21),(254±23),(270±24),(200±21) μg/L vs (80±9) μg/L] (P＜0.05 or P＜0.01);it reached the peak 5 d after hemorrhage,then was gradually decreased,and was not significantly different with that in control group 14 d after hemorrhage.Within 24 h after hemorrhage and 3,5,7,14 d after hemorrhage,MMP-9 was positively correlated with brain edema volume (r =0.742,0.783,0.835,0.754,0.693;P ＜0.01 or P ＜ 0.05);TIMP-1 and brain edema volume was negatively correlated within 24 h after hemorrhage and 7 d after hemorrhage (r =-0.455,-0.231;both P ＜ 0.05),was positively correlated 3 and 5 d after hemorrhage,and was not correlated 14 d after hemorrhage (P ＞ 0.05).Conclusion MMP-9 may be involved in all stages of cerebral edema formation,TIMP-1 may be involved in early brain edema formation only,so MMP-9 can better reflect the brain edema formation.%目的 探讨脑出血患者血清基质金属蛋白酶9(MMP-9)和金属蛋白酶组织抑制剂1(TIMP-1)水平的变化及其与脑水肿的相关性.方法 纳入延安大学附属医院2013年4月至2015年3月78例脑出血患者(脑出血组),另纳入同期健康体检者78名作为对照组.检测对照组入组后及脑出血组发病后24 h内和3、5、7、14d血清MMP-9和TIMP-1水平;CT检测脑出血组上述时点病灶处脑水肿体积,分析MMP-9、TIMP-1与脑水肿体积的相关性.结果 脑出血组发病后24 h内和3、5、7、14 d MMP-9水平均高于对照组[(226±31)、(246±32)、(254±34)、(240±32)、(227±31) μg/L比(54±8)μg/L],差异均有统计学意义(均P ＜0.05或P＜0.01),发病后5d达峰值,随后逐渐下降.脑出血组患者发病后24 h内和3、5、7 d TIMP-1水平均高于对照组[(176±21)、(254±23)、(270±24)、(200±21) μg/L比(80±9)μg/L],差异均有统计学意义(P＜0.05或P＜0.01),发病后5d达峰值,随后逐渐下降;发病后14d2组比较差异无统计学意义(P＞0.05).脑出血发病后24 h内及发病后3、5、7和14 d MMP-9水平与脑水肿体积呈正相关(r =0.742、0.783、0.835、0.754、0.693,P＜0.01或P＜0.05);发病后24 h内和发病后7d,TIMP-1水平与脑水肿体积呈负相关(r=-0.455、-0.231,均P＜0.05),发病后3和5d,TIMP-1水平与脑水肿体积呈正相关(r =0.632、0.708,P＜0.05或P＜0.01),发病后14 d TIMP-1水平与脑水肿体积无相关性(P＞0.05).结论 血清MMP-9可能参与脑水肿形成整个阶段,而TIMP-1可能仅参与早期脑水肿形成,故MMP-9可更好地反映脑水肿形成情况.