摘要目的 探讨重型颅脑损伤患者血清NSE、MMP-2及MMP-9蛋白水平变化及其临床意义.方法 采用前瞻性队列研究,收集重型颅脑损伤患者62例(死亡6例)及对照组20例,应用ELISA法检测血清中NSE、MMP-2及MMP-9水平,分析其变化趋势与临床病情变化和转归的关系.结果 各监测点重型颅脑损伤后患者血清NSE、MMP-2及MMP-9浓度显著增高(P＜0.01).NSE高峰出现在第5天,此后仍处于较高水平.MMPs在第5～7天仍持续性升高,提示患者可能预后不良甚至死亡.预后不良组患者伤后第1、3、5、7天血清MMP-2、MMP-9浓度显著高于相同时间点的预后良好组患者(P＜0.01).统计学分析表明,MMP-9在预后评估中价值最高,其次为MMP-2,而NSE预测价值最差.结论 血清NSE、MMP-2、MMP-9蛋白参与了急性颅脑损伤的病理生理过程,并可能在继发性脑损伤中起重要作用.其测定对于早期评估重型颅脑损伤的严重程度和预后有重要意义.

abstractsObjective To investigate the changes in the serum levels of neuron specific enolase (NSE) and matrix metalloproteinases-2 (MMP-2) and matrix metalloproteinases-9 (MMP-9) and their clinical significance in the patients with severe traumatic brain injury.Methods A prospective control study was carried out.The serum from 62 (including 6 patients who died in 6 months) TBI patients and 20 normal persons were collected to measure the levels of NSE,MMP-2 and MMP-9 by using ELISA and analyzed the change trend of them together with Glasgow Outcome Scale.Results The serum levels of NSE,MMP-2 and MMP-9 were significantly higher in the brain trauma group than those in the control group(P ＜0.0l).The serum levels of NSE peaked on 5th day,although dropping on the 7th day after brain trauma,was significantly higher in the brain trauma group than that in the control group.The serum levels of MMP-2,MMP-9 peaked on 1 st day and the second peak appeared on 5th day.The serum levels of NSE,MMP-2 and MMP-9 were significantly higher in the patients with poor prognoses group than those with good prognoses group(P ＜ 0.01).Conclusions NSE,MMP-2 and MMP-9 of the serum were involved in the pathological process of acute brain injury.Although there are several serious limitations of the use of NSE,MMP-2 and MMP-9 as a biomarker in traumatic brain injury,their concentrations may be useful as a practical and helpful screening test to identify neurotrauma patients who are at increased risk.