高血压脑出血后早期脑水肿血清MMP-9、BDNF及IL-18水平变化  

Changes in serum MMP⁃9,BDNF and IL⁃18 levels in early cerebral oedema after hypertensive cerebral hemorrhage

作　　者：王强 王萃 赵燕 张敏 王稳 WANG Qiang;WANG Cui;ZHAO Yan;ZHANG Min;WANG Wen(Department of Neurosurgery,Hengshui Second People's Hospital,Hengshui,Hebei,China,053000)

机构地区：[1]衡水市第二人民医院神经外科,河北衡水053000

出　　处：《分子诊断与治疗杂志》2024年第5期856-859,863,共5页Journal of Molecular Diagnostics and Therapy

基　　金：河北省医学科学研究项目(20220281);衡水市科技计划项目(2020014067Z)。

摘　　要：目的分析高血压脑出血后早期脑水肿血清基质金属蛋白酶9(MMP-9)、脑原性神经营养因子(BDNF)及白介素18(IL-18)水平变化。方法本研究采用回顾性、大样本、对照的方法,经纳入、排除标准,筛选2020年12月至2021年12月衡水市第二人民医院神经外科收治住院的高血压脑出血患者224例作为脑水肿组,据术后脑水肿指数大小将患者分为中高度脑水肿组102例和轻度脑水肿组122例,另选取同期于本院行体检的健康人群118名作为正常对照组。比较脑水肿组、正常对照组血清MMP-9、BDNF及IL-18水平;分析脑水肿组入院24 h、36 h、48 h、72 h血清MMP-9、BDNF及IL-18水平变化趋势;采用单变量分析影响脑水肿轻重程度的因素,采用多变量分析评估与脑水肿轻重程度独立相关的因素。结果脑水肿组血清MMP-9、IL-18水平均高于对照组,BDNF水平低于对照组,差异有统计学意义(P<0.05);脑水肿组随着时间增长,MMP-9、IL-18水平随之上升,差异具有统计学意义(P<0.05)。脑水肿组随着时间增长至48 h,BDNF水平逐渐降低,差异具有统计学意义(P<0.05)。高度脑水肿组、轻度脑水肿组高血压病程、入院时收缩压、入院时舒张压、GCS评分、术前瞳孔有改变、手术时间、血肿量、手术方式、MMP-9、BDNF及IL-18水平比较,差异有统计学意义(P<0.05)。将单变量分析中P<0.05的因素纳入二元Logistic回归模型中,经调整,发现高血压病程长、GCS评分低、手术时间长、血肿量高、手术方式为传统非显微手术、MMP-9及IL-18水平高、BDNF水平低是影响高血压脑出血早期脑水肿轻重程度的危险因素(P<0.05)。结论血清MMP-9、BDNF及IL-18水平与高血压脑出血后早期脑水肿的发生有密切联系,及时监测上述指标变化,对于降低脑水肿程度有十分重要的意义。Objective To analyze the changes of serum matrix metalloproteinase⁃9(MMP⁃9),brain⁃derived neurotrophic factor(BDNF)and interleukin⁃18(IL⁃18)in early brain edema after hypertensive cerebral hemorrhage.Methods In this study,a retrospective,large⁃sample,controlled method was used to screen 224 hypertensive cerebral hemorrhage patients admitted to the Department of Neurosurgery of the Sec⁃ond People's Hospital of Hengshui City as the cerebral oedema group from December 2020 to December 2021.Patients were classified into 102 cases of medium⁃high cerebral oedema and 122 cases of mild cerebral oedema according to the size of the cerebral oedema index after the operation.Additionally,118 healthy individuals who had medical check⁃ups in the same period atthe hospital were selected as the normal control group.To compare the serum levels of MMP⁃9,BDNF,and IL⁃18 in the cerebral oedema group and the normal control group,trends in these levels at 24 h,36 h,48 h and 72 h after admission to the hospital were analyzed.Uni⁃variate analysis was used to identify factors affecting the severity of cerebral oedema,and multivariate analysis was conducted to assess factors independently associated with the severity of cerebral oedema.Results The levels of serum MMP⁃9 and IL⁃18 in the cerebral oedema group were higher than those in the control group,while the BDNF level was lower than that of the control group,and the difference was statistically significant(P<0.05).As time progressed in the cerebral oedema group,the levels of MMP⁃9 and IL⁃18 continued to in⁃crease significantly(P<0.05).In the cerebral oedema group,over 48 hours,the level of BDNF gradually de⁃creased,and the difference was statistically significant(P<0.05).When comparing the duration of hyperten⁃sion,systolic blood pressure at admission,diastolic blood pressure at admission,GCS score,preoperative pu⁃pil changes,operation time,hematoma volume,operation method,and levels of MMP⁃9,BDNF,and IL⁃18 between the high cerebral oedema gro

关 键 词：MMP-9 BDNF IL-18 高血压 脑出血后 脑水肿 

分 类 号：R544.1[医药卫生—心血管疾病] R651.1[医药卫生—内科学]