Simon Daniel, Evaldt Joice, Nabinger Débora Dreher, Fontana Mariano Feraboli, Klein Mirelli Gabardo, do Amaral Gomes Julia, Regner Andrea
a Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde.
b Laboratório de Biomarcadores do Trauma.
Brain Inj. 2017;31(3):390-395. doi: 10.1080/02699052.2016.1259501. Epub 2017 Feb 3.
Matrix metalloproteinase-9 (MMP-9) is an inducible metalloproteinase that can degrade the cerebrovascular matrix leading to disruption of the blood-brain barrier and exacerbation of oedema in neurotrauma. Therefore, our aim was to determine whether MMP-9 plasma levels were associated with intensive care unit (ICU) mortality after severe traumatic brain injury (TBI) despite the presence of extracerebral injuries.
This cohort enrolled 80 patients who suffered severe TBI (Glasgow Coma Scale: 3-8 at hospital admission). The plasma MMP-9 level was determined by enzyme-linked immunosorbent assay assay at ICU admission.
Severe TBI was associated with a 32.5% ICU mortality rate. There was no association between the presence of extracerebral injuries (72.5% of the patients) and ICU mortality (P = 0.419). Higher plasma MMP-9 concentrations were associated with fatal outcome: 181.1 ± 16.0 ng/mL for survivors and 257.0 ± 23.2 ng/mL for nonsurvivors (mean ± S.E.M., P = 0.009). In contrast, there was no significant difference between MMP-9 levels and associated lesions: 220.8 ± 26.3 ng/mL for isolated TBI and 196.8 ± 15.8 ng/mL for patients with extracerebral injuries (P = 0.397).
Increased plasma MMP-9 levels predicted short-term fatal outcome following severe TBI, regardless the presence of extracerebral injuries.
基质金属蛋白酶-9（MMP-9）是一种可诱导的金属蛋白酶，它能够降解脑血管基质，导致血脑屏障破坏，并加重神经创伤中的水肿。因此，我们的目的是确定尽管存在脑外损伤，但严重创伤性脑损伤（TBI）后血浆MMP-9水平是否与重症监护病房（ICU）死亡率相关。
该队列纳入了80例遭受严重TBI的患者（入院时格拉斯哥昏迷量表评分：3-8分）。在ICU入院时通过酶联免疫吸附测定法测定血浆MMP-9水平。
严重TBI的ICU死亡率为32.5%。脑外损伤的存在（72.5%的患者）与ICU死亡率之间无相关性（P = 0.419）。较高的血浆MMP-9浓度与致命结局相关：幸存者为181.1±16.0 ng/mL，非幸存者为257.0±23.2 ng/mL（平均值±标准误，P = 0.009）。相比之下，MMP-9水平与相关损伤之间无显著差异：单纯TBI患者为220.8±26.3 ng/mL，脑外损伤患者为196.8±15.8 ng/mL（P = 0.397）。
血浆MMP-9水平升高预示着严重TBI后的短期致命结局，无论是否存在脑外损伤。
