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目的探讨脑脊液基质金属蛋白酶-9(MMP-9)在不同程度缺氧缺血性脑病(HIE)及其病程中的变化特征。方法选择HIE患儿60例作为研究对象,根据HIE严重性将其分为轻度、中度和重度HIE组,每组20例。HIE发病后第1、7、14天及第21天为研究时相点,在各时相点采用ELISA夹心法测定脑脊液MMP-9含量,床边监测aEEG;采用观察表记载临床资料。结果同一严重程度HIE在不同时相点测定的脑脊液MMP-9含量不同,轻度HIE组各时相点之间MMP-9含量比较差异无统计学意义(P>0.05);中度HIE组及重度HIE组各时相点之间MMP-9含量比较差异有统计学意义(P<0.05);同一时相点不同严重程度HIE测定的脑脊液MMP-9含量也不同,第1天MMP-9含量在三组之间两两比较差异均有统计学意义(P<0.05)。在第7天时轻度组和中度组,中度组和重度组之间两两比较差异均有统计学意义(P<0.05)。在第14、21天时,轻度组和重度组之间差异具有统计学意义(P<0.05)。第21天时相点不同预后的MMP-9之间差异有统计学意义(P<0.05),MMP-9含量与HIE预后具有弱相关性(P=0.007)。在第1天、第14天和第21天时相点,MMP-9含量变化与60例HIE具有一定的相关性(P<0.05)。结论脑脊液MMP-9含量与HIE的病情严重性相关联,MMP-9可作为预报HIE早期诊治、预测预后的指标。
Objective To investigate the changes of matrix metalloproteinase-9 (MMP-9) in cerebrospinal fluid (CSF) during different stages of hypoxic-ischemic encephalopathy (HIE) and its course. Methods Sixty children with HIE were selected as study subjects. According to the severity of HIE, they were divided into mild, moderate and severe HIE group, 20 cases in each group. On the 1st, 7th, 14th and 21st days after the onset of HIE, we studied the time points of the study. The levels of MMP-9 in the cerebrospinal fluid and the aEEG at the bedside were measured by ELISA sandwich method at each time point. Clinical data were recorded by the observation table. Results The levels of MMP-9 in cerebrospinal fluid of HIE at the same severity were different at different time points. There was no significant difference in MMP-9 levels between mild HIE groups at each time point (P> 0.05) The content of MMP-9 in cerebrospinal fluid of HIE group was significantly different at different time points (P <0.05). The content of MMP-9 in cerebrospinal fluid of HIE group at different time points was also different. The differences between the three groups were statistically significant (P <0.05). On the 7th day, the mild and moderate groups showed statistically significant differences (P <0.05) between the moderate and severe groups. At the 14th and 21st days, the difference between the mild and severe groups was statistically significant (P <0.05). The difference of MMP-9 between the different prognosis at the 21st day was statistically significant (P <0.05). There was a weak correlation between the content of MMP-9 and the prognosis of HIE (P = 0.007). The change of MMP-9 content at the 1st, 14th and 21st day was correlated with 60 cases of HIE (P <0.05). Conclusions The content of MMP-9 in cerebrospinal fluid is correlated with the severity of HIE. MMP-9 may be used as an index to predict early diagnosis and prognosis of HIE.