急性脑梗死病人颈动脉软斑块与血浆中高敏C反应蛋白、基质金属蛋白酶9有关  

Association Between Carotid Soft Plaque in Acute Ischemic Stroke are Associated with Increases in Serum High-sensitivity C-reactive Protein and High Matrix Metalloproteinases-9

作　　者：邓远琼[1] 柳超平[2] 易小红[2] 斯轶凡[1] 范华[3] 

机构地区：[1]南昌大学第四附属医院超声科,江西南昌330003 [2]南昌大学第四附属医院体检科,江西南昌330003 [3]南昌大学第四附属医院神经内科,江西南昌330003

出　　处：《中华高血压杂志》2008年第12期1125-1128,共4页Chinese Journal of Hypertension

摘　　要：目的探讨颈动脉斑块性质及高敏 C 反应蛋白(hsCRF)、基质金属蛋白酶9(MMP-9)与急性脑梗死的关系。方法应用彩色多普勒超声仪检测急性梗死病人(n=31)及年龄相近的无症状颈动脉斑块病人(n=42)颈动脉内膜中膜厚度(IMT)、斑块类型,同时测定血清的 hsCRP、MMP-9水平。结果急性脑梗死组及无症状颈动脉斑块组颈动脉 IMT 均明显增厚,两组颈动脉狭窄率差异无统计学意义;急性脑梗死组斑块以软斑为主,无症状颈动脉斑块组以硬斑为主。急性脑梗死组各亚组 hsCRP 水平均高于无症状颈动脉斑块组相应的亚组[急性脑梗死组狭窄率≥50%亚组:(12.0±4.6)mg/L 比无症状颈动脉斑块组狭窄率≥50%亚组(9.3±4.4)mg/L,P<0.05;急性脑梗死组狭窄率<50%亚组(7.8±4.6)mg/L 比无症状颈动脉斑块组狭窄率<50%亚组(4.2±2.4)mg/L,P<0.05];颈动脉狭窄程度越高,血清 hsCRP 水平越高;无症状颈动脉斑块组狭窄率≥50%亚组:(9.3±4.4)mg/L比无症状颈动脉斑块组狭窄率<50%亚组:(4.2±2.4)mg/L,P<0.05];急性脑梗死组 MMP-9水平均高于无症状颈动脉斑块组[急性脑梗死组两个亚组(256.4±87.6)和(243.8±31.3)μg/L 比无症状颈动脉斑块组两个亚组(158.6±76.4)和(147.4±26.4)μg/L,P<0.05];软斑病人 hsCRP、MMP-9水平明显高于非软斑组[hsCRP,软斑组(12.2±3.1)比非软斑组(5.0±3.4)mg/L,P<0.01;MMP-9,软斑组(263.4±39.5)比非软斑组(152.6±51.7)μg/L,P<0.01]。且软斑组 hsCRP 与 MMP-9呈正相关(r=0.67,P<0.01)。结论软斑为急性脑梗死的重要危险因素;hsCRP 与 MMP-9增高,提示斑块软化破裂以及炎症因素是急性脑梗死重要发病机制。Objective To explore the association between plaque characteristics and high-sensitivity C-reactive Protein（hsCRP）, matrix metalloproteinases-9 （MMP-9） in the patients of acute ischemic stroke. Methods The intima-media thickness （IMT）, plaque type of carotid artery were examined by color Doppler, and the serum hsCRP and MMP-9 were determined in patients with acute cerebral infaretion（ACI, n= 31） and age match non-symptomation carotid plaque patients （ NSP, n= 42 ）. Results The carotid IMT thickeness were obviously greater both in acute cerebral infarction patients （1.15 ± 0.28 mm） and asymptomatic carotid artery plaque patients （1.16 ±0.24 mm）; Soft plaque are predominent in ACI, while hard plaques are major portion in NSP; hsCRP levels in ACI （All P〈0.05）. The greater the extent of carotid stenosis, the higher the hsCRP levels in serum was shown（All P〈 0.05）. ACI patients have higher MMP-9 levels than those in NSP（All P〈0.05）. Base on the characteristics of plaques we pooled all soft plaque in ＂soft sub-group＂. Patients with soft plaque are associated with higher hsCRP （soft plaque group： 12.2±3.1 mg/L vs non-soft plaque group： 5.0±3.4 mg/L, P〈0.01） and higher serum MMP-9 （soft plaque group： 263.4±39.5 vs non-soft plaque group：152.6±51.7 μg/L, P〈0.01）. A positive correlation between the hsCRP and MMP-9 levels in soft plaque group was found （r=0.67, P〈0.01）. Conclusion Soft plaque is an important risk factor of stroke. Enhanced production of hsCRP, MMP-9 seems participate in the development of unstable plaque, hsCRP level as an inflammation index may predict the stability and the extent of carotid artery plaque.

关 键 词：脑梗死 动脉粥样硬化斑块 超声检查 高敏C反应蛋白 基质金属蛋白酶9 

分 类 号：R743.33[医药卫生—神经病学与精神病学]