高血压脑出血不同手术方式对血清MMP-9、TNF-α表达的影响

【摘要】目的探讨不同手术方式对高血压脑出血(HICH)患者术后血清基质金属蛋白酶-9（MMP-9）及肿瘤坏死因子-α（TNF-α）表达及血肿周围水肿(PHE)的影响。方法选取166例急性脑出血患者为研究对象，随机分为锁孔内镜组（83 例）及大骨瓣开颅组（83 例），另选同期健康体检者30例作为对照组，对比分析对照组体检时及两手术组不同时间点血清TNF-α、MMP-9质量浓度，通过CT扫描来观察术后PHE状况，并计算不同时间节点的重度水肿率。结果术前两手术组血清TNF-α、MMP-9质量浓度比较，差异无统计学意义（P>0.05），与对照组对比明显升高（P<0.05），术后1 d、3 d、7d、14 d锁孔内镜组血清MMP-9、TNF-α质量浓度明显低于大骨瓣开颅组（P<0.05），重度水肿率小于大骨瓣开颅组（P<0.05）。结论锁孔内镜手术方式可更好地降低血清TNF-α、MMP-9炎性因子水平表达，有效减少脑出血患者术后脑水肿，更有利于患者术后神经功能恢复。

Abstract: ObjectiveTo investigate the effects of different surgical methods on the expression of serum matrix metalloproteinase-9(MMP-9), tumor necrosis factor-α(TNF-α) and perihematoma edema(PHE) in patients with hypertensive intracerebral hemorrhage(HICH). Methods166 patients with acute intracerebral hemorrhage were randomly divided into keyhole endoscopy group(83 cases) and large bone flap craniotomy group(83 cases), and 30 healthy subjects in the same period were selected as the control group. The mass concentrations of serum TNF-α and MMP-9 in the control group and the two operation groups at different time points were compared and analyzed. The postoperative PHE status was observed by CT scanning, and the severe edema rate at different time points was calculated. ResultsThere was no significant difference in the mass concentrations of serum TNF-α and MMP-9 between the two operation groups before operation(P>0.05), which was significantly higher than that in the control group(P<0.05). The mass concentrations of serum MMP-9 and TNF-α in the keyhole endoscopy group were significantly lower than those in the large bone flap craniotomy group(P<0.05), and the rate of severe edema was lower than that in the large bone flap craniotomy group(P<0.05). ConclusionKeyhole endoscopic surgery can better reduce the expression of serum TNF-α and MMP-9 inflammatory factors, effectively reduce postoperative brain edema in patients with intracerebral hemorrhage, and is benificial to recovery of postoperative neurological function.