| Objective:(1)To study changes of serum MMP-9(matrix metalloproteinase-9)and S100β(astrocytic calcium binding protein)in the pathogenesis of acute atherosclerotic cerebral infarction(AACI),the correlation was analyzedbetween MMP-9 、 S100βand ACI.(2)By butylphthalide combined with transcranial magnetic stimulation treatment to understand the changes of MMP-9、S100βand the clinical efficacy of ACI after treatment,in order to further explore the butylphthalide combined with transcranial magnetic stimulation on atherosclerotic cerebral infarction(ACI)treatment effect and possible mechanism of treatment.Methods:(1)prospective;(2)randomized controlled trial.1.Methods 320 patients with acute atherosclerotic cerebral infarction(AACI)who were hospitalized in our hospital from January 2015 to December 2016 were enrolled in this study。2.They were randomly divided into four groups according to the admission order:Group A(conventional treatment),B group(Basic treatment +dl-3-n-butylphthalide),C group(Basic therapy + rTMS therapy),D group(Basic therapy + dl-3-n-butylphthalide +rTMS treatment),each group had 80 cases.3.All patients before admission to improve the three conventional,kidney、liver function,myocardial enzymes,chest X-ray,ECG,heart color Doppler ultrasound and carotid artery color Doppler ultrasound,according to the standard and then the patients into the group。4.The following indexes were detected at the beginning of treatment and 12 weeks after treatment:(1)ELISAmethodwas used to detect the levels of MMP-9 and S100βin serum of patients;(2)NIHSS score;(3)MRSscore;(4)Magnetic resonance perfusion imaging(PWI)was used to observe the following parameters: rCBF(local cerebral-blood-flow);rCBV(local cerebral-blood-volume);rMTT(local mean-transit-time);rTTP(local peak-time);(5)liver function、renal function、myocardial enzymes.2.Using SPSS18 software for statistical analysis;P< 0.05 was statistically significant.Results:(1)Before treatment,A B,C,D four groups of MMP-9,S100 beta,NIHSS score,MRS score,rCBF,r CBV,rMTT,rTTP,average age,gender and other clinical data showed no obvious difference(P> 0.05);The levels of MMP-9 and S100 were increased with the increase of NIHSS score(r=0.893,P=0.000 < 0.01;r=0.851,P=0.000 < 0.01).(2)After treatment,the contents of MMP-9 and S100βin A,B,C and D groups were lower than those before treatment(MMP-9 :196.22:349.04、180.84:348.84、187.15:347.90、170.76:349.53;S100β:0.57:1.15、0.47:1.17、0.48:1.14、0.39:1.13)(P< 0.05);After 12 weeks of treatment,the MMP-9 and S100 beta in B,C and D groups were decreased significantly compared with A group(MMP-9 :180.84:187.15:170.76: 196.22;S100β:0.47:0.48:0.39:0.57)(P< 0.05),and the content of MMP-9 and S100βin the D group was significantly lower(MMP-9=170.76 ng/ml;S100β=0.39μg/L).(3)After treatment,the NIHSS scores of A,B,C,D four groups were lower than those before treatment(6.69:12.19、5.57:12.06、5.38:11.98、4.82:12.15)(P<0.05);After 12 weeks of treatment,the NIHSS scores of B,C and D groups were decreased significantly compared with A group(5.57:5.38:4.82:6.69)(P<0.05),and the NIHSS scores of D group was more obvious(NIHSS评分=4.82).(4)Over treatment,the MRS scores of A,B,C,D four groups were lower than those before treatment(3.66:4.23、3.20:4.16、3.24:4.24、2.78:4.21)(P<0.05);After 12 weeks of treatment,the MRS scores of B,C and D groups were decreased significantly than those of A group(3.20:3.24:2.78:3.66)(P<0.05),and the MRS score of D group was more obvious(MRS评分=2.78).(5)After treatment,the rCBF and rCBV of A,B,C,D four groups were increased compared with before treatment(rCBF:53.36:33.5、62.55:33.24、61.95:33.04、68.41:33.68;rCBV:1.12:0.72、1.21:0.70、1.26:0.75、1.33:0.73)(P<0.05),rMTT and rTTP were shorter than before treatment(rMTT:13.5:15.5、11.99:14.99、11.29:14.86、10.31:15.05;rTTP:39.5:44.5、37.1:44.1、36.43:44.41、34.64:44.63)(P< 0.05);After 12 weeks of treatment,the rCBF and rCBV of B,C and D groups were increased significantly than those of A group(rCBF:62.55:61.95: 68.41: 53.36;rCBV:1.21:1.26:1.33:1.12)(P<0.05),and the rCBF and rCBV in the D group were significantly increased(rCBF=68.41 ml/(100g·min);r CBV=1.33ml/g);After 12 weeks of treatment,the rMTT and rTTP of B,C and D groups were shorten significantly than those of A group(rMTT:11.99:11.29:10.31:13.5;rTTP: 37.1:36.43:34.64:39.5)(P< 0.05),and the rMTT and rTTP in the group D were significantly shorter(rMTT=10.31s;r TTP=34.64s).(6)A course of treatment and after treatment,liver function、renal function、myocardial enzyme of patients in each group were normal;there is no bleeding,allergies and other side effects.Conclusion: Elevated serum levels of MMP-9 and S100βmay be associated with the onset of ACI.Butylphthalide combined with transcranial magnetic stimulation may improve neurological function and prognosis in patients with acute atherosclerotic cerebral infarction by reducing serum MMP-9 and S100 beta levels. |
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