腦脊髓液中MMP-9濃度變化與腦損傷病患預後預測之相關性

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Title:	腦脊髓液中MMP-9濃度變化與腦損傷病患預後預測之相關性 The Correlation between the Changes of MMP-9 Levels in Cerebrospinal Fluid and Prediction of Prognosis in Head Injury Patients
Authors:	劉俊麟;Chun-Lin Liu
Contributors:	醫學院臨床醫學研究所碩士班
Keywords:	生化因子;腦脊髓液;MMP-9;biomarkers;CSF;MMP-9
Date:	2010
Issue Date:	2010-09-29 12:16:50 (UTC+8)
Abstract:	關於生化因子變化對腦損傷病患預後影響的預測，向來是吾輩努力研究的方向。MMP-9，一種具專一性的基質溶解酶，已被許多論文提出具備預測神經系統疾病預後的潛力。但過去均以實驗動物或病患之血液或腦組織進行相關研究，並無以腦脊髓液進行相關研究之論述。是以本次研究的目的，主要針對腦脊髓液為研究對象，針對腦損傷病患抽取其腦脊髓液，加以分析其中MMP-9含量之變化，以尋求其中之規則。臨床上受限於醫學倫理議題，大規模抽取正常人之腦脊髓液實有困難，因此對照組來源以臨床上有水腦症需進行手術治療之病患為主；於手術中抽取腦脊髓液進行常規檢測時加測MMP-9含量。實驗組則針對外傷性腦出血病患，臨床上判斷需進行手術治療且有放置腦室外引流管者，逐日收集引流出來的腦脊髓液進行分析，每一病患連續收集十日。其中對照組部分，共收集到85位病患檢體。分析後其濃度與性別及年齡並無相關，其平均濃度為1.172±0.859 ng/mL。此數值應為目前首次獲得人體腦脊髓液中MMP-9濃度之參考數值。實驗組則收集到8位頭部外傷病患，共59份檢體。有2人死亡，6人存活。存活病患經分析濃度變化後，可得知MMP-9平均值變化於前三日最明顯，呈線性相關，於第三日可恢復至跡近正常參考值。至於其他關連性，則因樣本數目仍不夠充足，尚未能建立其明確相關性。但可約略發現其數值變化與昏迷指數呈負相關。進一步深入研究仍屬必要。 Traumatic brain injury (TBI) is a common cause induced severe brain damages. There are many controversals in clinical management for such condition. The outcome prediction is more difficult. Though several tools developed but precisely outcome prediction not available yet. There are many biomarkers mentioned before but no one can put into clinical practice. Matrix metalloproteinase 9 (MMP-9), one of the protein rich in supportive tissue over central nervous system, was mentioned to be potential in outcom prediction for neuron damage. There are many articles try to clarify the connection between MMP-9 and brain damages. Now we try to build up how the MMP-P convinced the outcome prediction in traumatic brain injuries. We correct the cerebro-spinal fluid from ventricular puncture during ventriculo-peritoneal shunt (VP shunt ) surgery for patients with hydrocephalus. Then we calculated the concentration of MMP-9 in CSF. Eighty-five patients were involved and the average concentration of MMP-9 in CSF is 1.172±0.859 ng/mL. The concentration is not influenced by several factors such as gender and age. It’s the first available data of MMP-9 concentration is CSF. We also collect the cerebrospinal fluid from 6 head injury patients received surgical intervention with external ventricular drainage insertion. After analysis, we found it that MMP-9 concentration elevated immediately after head injury. Besides, the concentration of MMP-9 decreased within 72 hours and became nearly within the normal range.
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