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目的探讨颈动脉粥样斑块稳定性及炎症反应与急性脑梗死之间的关系。方法对71例急性脑梗死患者(A组)、44例无症状颈动脉硬化患者(B组)和21例健康对照者(C组)进行研究,ELISA测定基质金属蛋白酶-9(MMP-9)、组织型基质金属蛋白酶抑制剂-1(TIMP-1)含量,免疫透射比浊法测定高敏C反应蛋白(hs-CRP)含量,应用彩色多普勒超声仪观测颈动脉内中膜厚度(IMT)、斑块类型及斑块形态。结果A组颈动脉IMT[(1.11±0.29)mm]和B组IMT[(1.14±0.26)mm]与C组[(0.77±0.15)mm]比较差异有统计学意义(P<0.05);A组颈动脉斑块以脂质型斑块(59.2%)为主,B组以纤维型斑块(32.9%)为主,A组斑块表面多呈不规则型。hs-CRP、MMP-9含量在A组[分别为(5.47±2.26)mg/L、(250.64±89.65)ng/ml]、B组[分别为(1.80±0.34)mg/L、(144.67±34.40)ng/ml]、C组[分别为(0.59±0.12)mg/L、(64.49±18.26)ng/ml]之间差异有统计学意义;TIMP-1含量在A组[(59.64±15.87)ng/ml]、B组[(73.48±21.22)ng/ml]和C组[(57.95±7.86)ng/ml]之间差异有统计学意义,但A组和C组间差异无统计学意义;A组hs-CRP与MMP-9(r=0.241,P=0.043)呈正相关。结论颈动脉粥样斑块稳定性与急性脑梗死有关,MMP-9、TIMP-1参与的炎症反应是影响颈动脉粥样斑块由结构性不稳定向功能性不稳定进展的重要机制。
Objective To investigate the relationship between carotid atherosclerotic plaque stability and inflammatory response and acute cerebral infarction. Methods 71 patients with acute cerebral infarction (group A), 44 asymptomatic patients with carotid atherosclerosis (group B) and 21 healthy controls (group C) were studied. The levels of matrix metalloproteinase-9 (MMP-9) , Tissue inhibitor of metalloproteinase-1 (TIMP-1) and hs-CRP in the immunostaining turbidimetric method. The carotid intima-media thickness (IMT) was measured by color Doppler ultrasonography ), Plaque type and plaque morphology. Results The IMT of carotid artery (1.11 ± 0.29) mm in group A and IMT in group B [(1.14 ± 0.26) mm] were significantly different from those in group C [(0.77 ± 0.15) mm] (P <0.05) Group carotid plaque with lipid plaque (59.2%), B group with fibrous plaque (32.9%), A group of plaque surface mostly irregular. The levels of hs-CRP and MMP-9 in group A [(5.47 ± 2.26) mg / L, (250.64 ± 89.65) ng / (P <0.05). There was a significant difference between the two groups (P> 0.05), 34.40 ng / ml] and C group [(0.59 ± 0.12) mg / L and (64.49 ± 18.26) ng / ) in group B [(73.48 ± 21.22) ng / ml] and group C [(57.95 ± 7.86) ng / ml], but there was no significant difference between group A and group C Significance; hs-CRP in group A was positively correlated with MMP-9 (r = 0.241, P = 0.043). Conclusion The stability of carotid atherosclerotic plaque is related to acute cerebral infarction. The inflammatory reaction involved in MMP-9 and TIMP-1 is an important mechanism that affects the progression from structural instability to functional instability of carotid plaque.