Observation Of The Effect Of Nimodipine On Concentration Of Serum Matrix Metalloproteinases-9(MMP-9) And Peripheral WBC Counts In The Acute Cerebral Infarction

Objective By determining concentration of serum matrix metalloproteinases-9 (MMP-9) and peripheral WBC counts of the acute cerebral infarction patients, and by observing their changes impacted by nimodipine, the research used enzyme-linked immunosorbent assay to explore clinical significance of the changes of acute cerebral infarction patients' MMP-9 concentration and WBC counts, and the new anti-inflammatory mechanism of nimodipine in acute cerebral infarction, further, it also explored the effect of calcium overload and calcium antagonists in cerebral ischemic injury. Meanwhile, the research combined with Edinburgh-Scandinavian nerve functional deficit scale (SNFD) and Barthel index to observe the relation between MMP-9 concentration and WBC counts and nervous action's changes, to evaluate acute cerebral infarction's clinical result affected by MMP-9 concentration and WBC counts, and to afford accordance for the further clinical appliance of nimodipine.Methods The research chose 124 cerebral infarction patients and divided into 2 average groups: A group (nimodipine + routine medicines), B group (routine treatment). The patients of two groups had no difference in age, sex, past history, ,SNFD and Barthel index (P>0.05). Give two groups routine treatment (antiplatelete treatment, protecting brain, promoting cerebral metabolism, 20% mannitol for cerebral edema patients), while the second group added oral nimodipine, 30 mg, tid(nasal feeding those who can't take food with ventricular canal). 40 patients of the contrast group came from healthy people passing physical examination. The diagnosis standard of cerebral infarction bases on the standard that was established in the fourth national academic conference in 1995—verified by brain CT and MRI. Meanwhile it need to exclude the following circumstances: (1) having severe disease of heart, liver or kidney or having malignant rumor;(2) having infectious history last two weeks;(3) having sign of secondary infection in hospital;(4) having had stroke, myocardial infarction or big operation last year. Before receiving treatment, the cerebral infarction patients should be tested Edinburgh-Scandinavian nerve function deficit scale and Bathel index. They should be tested again after two weeks' treatment. These patients were divided into four groups according to infarction area: large area infarction group, middle area infarction group, small area infarction group and lacunar infarct group. The contrast group was drawn 3-5 ml venous blood on an empty stomach in the morning;after being in hospital, the cerebral infarction patients should be drawn blood on empty stomachs in 24 hours before taking medicine and 5days and 14 days after taking medicine in the morning;then test serum MMP-9 concentration with Enzyme-linked immunosorbent assay. At the same time, draw peripheral blood and test WBC counts. Result1. Serum MMP-9 concentration and WBC counts of cerebral infarction patients showed significant dynamic changes: they began to arise in 24h (p<0.05), got the peak on the fifth day, decreased significantly on fourteenth day.. The large area group and middle area group showed most significant, while the small area group and lacunar infarct group were not significant.2. Repeated measurement data's three-factor analysis of varianceFactor 1: different group (A group: nimodipine + routine treatment;B group: routine treatment)Factor 2: different infarction area (large area, middle area, small area and lacunar infarct)Factor 3: different Treatment time (before treatment, the fifth day after treatment, the fourteenth day after treatment).Result: (1) The effect of factor 1 had significant difference for MMP-9 and WBC. This showed nimodipine can decrease significantly the MMP-9 and WBC of cerebral infarction patients on the fifth and fourteenth day in big area group, and can shortencourse of diseases compared to infarction group 1 with the same time and area(p<0.01). On the fourteenth day, group 2 had been near normal. (2) The effect of factor 2 had significant difference. The bigger infarction area is, the higher MMP-9 and WBC are and the longer time is, and it showed dynamic changes. The big area group showed most significant compared to other area group with the same treatment time (p<0.05). (3). Factor 3 had significant difference. (The same treatment and area group was compared to those before treatment. P<0.05). (4). The interaction of factor 1 and factor 2 had significant difference (p<0.05). It showed different CT type with different treatment had different effect. Nimodipine can decrease MMP-9 and WBC of big and middle area group patients significantly on the fifth and fourteenth day, while this effect was not significant in small area and lacunar infarct group.3. Repeated measurement data's two-factor analysis of variance(1). SNFD: the comparison between A group before and after treatment. (p<0.01);the comparison between B group before and after treatment(p<0.05);the comparison between A group and the B group after treatment(p<0.01).(2). BI: it was same with last item.These showed the comparison of SNFD and BI between A group and A group had significant difference (p<0.01), nimodipine can improve nerve functional deficit scale and BI.Conclusion 1. The serum MMP-9 concentration and WBC count increased significantly in acute cerebral infarction patients and showed dynamic change with the disease's development: they arose in 24h, got peak on the fifth day, and decreasedsignificantly on the fourteenth day. The big area group showed most significantly. Prompt: Count based on the MMP-9 density and WBC may diagnosis acute cerebral infarction patients on early time and forecast condition and prognosis of cerebral infarction patients.As the important targets, MMP-9 and WBC may also judgment Condition and prognosis of cerebral infarction patients. 2. The dynamic change of serum MMP-9 has highly positive correlation to WBC count in acute cerebral infarction patients. Prompt: In the acute stage of cerebral infarction, MMP-9 participates in the inflammation which damaged of brain ischemia responds that, and it is one of the impotant fectors which lead inflammation response. 3. Nimodipine can decrease serum MMP-9 and WBC of cerebral ischemia significantly, improve nerve functional deficit symptom and decrease BI. Prompt: Nimodipine ,as a calcium antagonist ,may hinde production of the cell factors which lead the inflammation response .It may participate in the anti- inflammation process...