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目的评价短暂脑缺血发作(TIA)是否具有脑保护作用并探讨其机制。方法选择2000～2004年142例脑梗死病人。脑梗死前有 TIA 病史者分为3组,A 组30例,TIA 持续时间10 min;B 组30例,TIA 持续时间10～20min;C 组30例,TIA 持续时间20min;52例无 TIA 病史者列为 D 组。采用欧洲脑卒中神经功能缺损评分标准(ESS),对各组患者人院后24 h、21d 及发病后3个月进行神经功能评分;应用 Pullicino 等公式对各组病人发病21d 时进行脑梗死体积计算;应用酶联免疫吸附法测定各组病人发病12、24、48、72、96 h 时血清 MMP-9的水平。结果 A、B、C 3组病人神经功能评分明显高于 D 组,B 组病人明显高于 A、c两组;发病21 d 时,A、B、C 3组病人梗死体积明显小于 D 组,B 组最明显;每组患者血清 MMP-9的水平呈动态变化即发病12 h 开始增高,48 h 达到高峰,96 h 时恢复到正常水平。B 组病人在不同时间点血清 MMP-9的含量明显低于 A、C 两组,且明显低于 D组。结论缺血耐受在脑梗死前合并 TIA 的患者可能发挥作用。其作用可以与 MMP-9的表达减少有关。
Objective To evaluate whether cerebral ischemic attack (TIA) has neuroprotective effect and to explore its mechanism. Methods 142 cases of cerebral infarction were selected from 2000 to 2004. TIA history before cerebral infarction were divided into three groups, A group of 30 cases, TIA duration of 10 min; B group of 30 cases, TIA duration of 10 ~ 20min; C group of 30 cases, TIA duration of 20min; 52 cases without TIA history As a group D. Neurological deficit score (ESS) was used to evaluate the neurological function of patients in each group at 24 h, 21 d and 3 months after onset of illness. The formula of Pullicino was used to evaluate the cerebral infarction volume The level of serum MMP-9 was measured at 12,24,48,72,96 h after onset of disease by enzyme-linked immunosorbent assay. Results The scores of neurological function in group A, B and C 3 were significantly higher than those in group D, and those in group B were significantly higher than those in group A and C. At 21 d, the volume of infarction in group A, B and C was significantly smaller than that in group D, The level of serum MMP-9 in each group showed a dynamic change, that is, the level of MMP-9 in each group began to increase at 12 hours, peaked at 48 hours, and returned to normal level at 96 hours. The levels of serum MMP-9 in group B were significantly lower than those in groups A and C at different time points, which were significantly lower than those in group D. Conclusion Ischemic tolerance may play a role in patients with TIA before cerebral infarction. Its role may be related to the reduced expression of MMP-9.