摘要
目的探讨脑梗死颈动脉粥样硬化(AS)斑块的形成及其稳定性与基质金属蛋白酶-9(MMP-9)的相关性及阿托伐他汀干预后MMP-9的变化。方法急性脑梗死患者148例,根据入院后颈动脉彩超结果,分为颈动脉AS斑块阳性组59例,AS斑块阴性组89例,其中前者分为稳定斑块组32例、不稳定斑块组27例。各组予阿司匹林100毫克/日、阿托伐他汀20毫克/日口服等干预治疗(其中有两例因服用阿托伐他汀肝功能损害而退出本研究),同时于治疗前及治疗后2周、4周、12周晨空腹抽取患者肘静脉血,采用双抗体夹心ELISA法测定血清中MMP-9含量。结果颈动脉AS斑块阳性组MMP-9水平(稳定斑块组229.75±80.67ug/L,不稳定斑块组342.98±119.45ug/L)高于阴性组(127.64±38.52ug/L),提示MMP-9与AS斑块的形成有一定的相关性;不稳定斑块组MMP-9水平(342.98±119.45ug/L)明显高于稳定斑块组(229.75±80.67ug/L)及AS斑块阴性组(127.64±38.52ug/L),显示颈内动脉斑块的稳定性与MMP-9密切相关;阿托伐他汀治疗后2周三组血清MMP-9水平分别由229.75±80.67ug/L、342.98±119.45ug/L、127.64±38.52ug/L明显下降至160.45±49.48ug/L、201.47±79.64ug/L、108.67±36.12ug/L,说明他汀类药物起效较快,作用显著;至第4周进一步降至110.34±34.11ug/L、159.66±42.58ug/L、93.73±33.21ug/L,第12周为98.45±32.89ug/L、128.31±40.77ug/L、87.34±30.51ug/L(仍高于正常),表明AS斑块的干预是一个长期的过程,这有助于防止AS斑块的增大及破裂,直接关系到脑梗死患者的预后。结论 MMP-9在颈动脉AS斑块的发生、发展过程中起重要作用,其分泌的增加是斑块不稳定的基础。同时,MMP-9也可作为脑梗死患者颈动脉不稳定性AS斑块干预手段的疗效监测指标。
Objective To explore the information of carotid artery atherosclerosis plaques in cerebral infarction and their stablity,as well as the relationship between MMP-9 and carotid artery atherosclerosis plaques and MMP-9’s changes after treatment of statine.Methods 148 acute cerebral infarciton patients were divied into 2 groups according to their carotid ultrosound results.There were 59 patients in positive carotid group and 89 patients in negative carotid group.In positive group,32 subjects were in stable carotid plaques group and 27 subjects were in vulnarable carotid plaques group.Asprin(100mg/d)and atorvastatin(20mg/d)were administrated to subjects(2 subjects dropped out because of the liver dysfunction).The median cubital vein blood were drawn on an empty stomach morning respectively before treatment,2 weeks,4 weeks and 12 weeks after treatment.The concentration of MMP-9 were detected by the double antibody sandwich ELISA method.Results The concentration of MMP-9 in positive carotid group(in stable carotid plaques group :229.75±80.67ug/L,in vulnerable carotid plaques group:342.98±119.45ug/L)were higher than those in negative carotid group(127.64±38.52ug/L),which suggested the relationship between MMP-9 and the information of carotid artery atherosclerosis plaques.The concentraion of MMP-9 in vulnerable plaques group(342.98±119.45ug/L)were much higher both than those in stable plaques group(229.75±80.67ug/L)and negative carotid group(127.64±38.52ug/L),which indicated the stability of carotid plaques were closely related to MMP-9.The concentration of MMP-9 in three groups 2 weeks after treatment decreased respectively from 229.75±80.67ug/L,342.98±119.45ug/L and 127.64±38.52ug/L to 160.45±49.48 ug/L,201.47±79.64ug/L and 108.67±36.12ug/L.It suggested that statine had quick acting and excellent efficacy.The concentration of MMP-9 in three groups 4 weeks after treatment decreased right along to 110.34±34.11 ug/L,159.66±42.58ug/L and 93.73±33.21 ug/L,and 98.45±32.89 ug/L,128.31±40.77ug/L and 87.34±30.51 ug/L respectively 12 weeks after treatment,though still above normal.It showed that it would be a long-term process to intervene in the carotid artery atherosclerosis plaques with statine.It was helpful to prevent the accretion and rupture of carotid plaques with statine,which directly related to the prognosis of cerebral infarction patients.Conclusion MMP-9 plays an important role in process of occurrence and development of carotid artery atherosclerosis plaques.The increase of MMP-9 secretion is the foundation of vulnerable plaques.Meanwhile,concentration of MMP-9 could serve as a monitor index for vulnerable plaques when intervened with medicines.
出处
《脑与神经疾病杂志》
2010年第5期321-324,共4页
Journal of Brain and Nervous Diseases
基金
上海市卫生局基金项目(2007124)
关键词
脑梗死
颈动脉粥样斑块
基质金属蛋白酶-9
Cerebral infarction
Carotid artery atherosclerosis plaques
Matrix metalloproteinase-9
