血漿基質金屬蛋白酶-9與缺血性卒中出血轉化關系的系統評價_《中國循證醫學雜志》

作者：

曹心慧 ,  劉鳴 , 吳波

四川大學華西醫院神經內科（成都 610041 ）;

關鍵詞：

基質金屬蛋白酶-9 出血轉化溶栓治療系統評價

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目的　了解血漿基質金屬蛋白酶-9（matrix metalloproteinase-9, MMP-9）與缺血性卒中出血轉化的關系，以便為患者選擇恰當的溶栓治療和臨床應用基質金屬蛋白酶抑制劑，擴大溶栓治療時間窗以及進一步臨床研究提供參考依據。
方法　納入血漿MMP-9與缺血性卒中出血轉化關系的臨床研究，根據血漿MMP-9水平是否高于界值、隨訪發生出血轉化的情況，或者根據是否有出血轉化比較血漿MMP-9水平的臨床研究，發表語種不限。按照缺血性腦血管病、MMP-9和出血轉化的同義詞和不同的拼寫形式組成檢索式分別在MEDLINE（1966～2006.4）和EMBASE（1966～2006.4）以及漢語檢索工具CNKI（1977～2006.2）和萬方數據庫（1989～2005）檢索，并根據選出文章的參考文獻目錄追蹤檢索。根據研究類型，按照預后研究方法學評價的主要標準，由兩位研究者獨立評價研究質量，意見不一致時請第三方協助評價。提取出血轉化組和非出血轉化組病例數相應的MMP-9值和logistic回歸分析的OR。使用RevMan4.2和SPSS11.0進行統計學處理。
結果　共納入6個研究，包括558例缺血性卒中患者，出血轉化者130例（23.3%）。納入研究的方法學質量較高。各研究間異質性較大（P lt;0.000 1）。組間血漿MMP-9水平沒有進行Meta分析，多數研究認為出血轉化組血漿MMP-9水平高于無出血轉化組，或某型出血轉化組血漿MMP-9水平高于無出血轉化組。亞組分析發現血漿MMP-9水平與出血轉化獨立相關， OR合并=14.45，95%CI（4.90，43.65）。
結論　出血轉化或某亞型患者血漿MMP-9水平高于無出血轉化者；MMP-9可能是出血轉化的獨立危險因素；但現有的研究病例數較少，上述發現還需要更多的研究予以證實。

引用本文： 曹心慧,劉鳴,吳波. 血漿基質金屬蛋白酶-9與缺血性卒中出血轉化關系的系統評價. 中國循證醫學雜志, 2006, 06(5): 361-369. doi: 復制

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2.	劉建平. 非隨機研究的系統評價方法. 中國循證醫學, 2001; 1(4): 239～243.
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9.	Gasche Y, Fujimura M, Morita- Fujimura Y, et al. Early appearance of activated matrix metalloprotienase-9 after focal cerebral ischemia in mice: a possible role in blood-brain barrier dysfuntion. J Cereb Blood Metab, 1999; 19(9): 1020-1028.
10.	Wang JL. Clinical epidemiology-design, weigh, and evaluation of clinical research. Edi 2. Shanghai: Shanghai Publishing Company of Science and Technology; 2001. 297.
11.	Liu JP. Method to systematic reviews of non-RCT. Chinese Journal of Evidence-Based Medicine, 2001; 1(4): 239-243.
12.	Liu JP. Method to systematic reviews of non-RCT. Chinese Journal of Evidence-Based Medicine, 2002; 2(1): 44-48.
13.	Castellanos M, Leila R, Serena J, et al. Plasma Cellular-Fibronectin Concentration Predicts Hemorrhagic Transformation After Thrombolytic Therapy in Acute Ischemic Stroke. Stroke, 2004; 35(7): 1671-1676.
14.	Montaner J, Molina CA, Monasterio J, et al. Matrix Metalloproteinase-9 Pretreatment Level Predicts Intracranial Hemorrhagic Complications After Thrombolysis in Human Stroke. Circulation, 2003; 107(4): 598-603.
15.	Montaner J, Fernández-Cadenas I, Molina CA, et al. Safety Profile of Tissue Plasminogen Activator Treatment Among Stroke Patients Carrying a Common Polymorphism (C-1562T) in the Promoter Region of the Matrix Metalloproteinase-9 Gene. Stroke, 2003; 34(12): 2851-2855.
16.	Montaner J, Alvarez-Sabín J, Molina CA, et al. Matrix Metalloproteinase Expression Is Related to Hemorrhagic Transformation After Cardioembolic Stroke. Stroke, 2001; 32(12): 2762-2767.
17.	Castellanos M, Leira R, Serena J, et al. Plasma Metalloproteinase-9 Concentration Predicts Hemorrhagic Transformation in Acute Ischemic Stroke. Stroke, 2003; 34(1): 40-46.
18.	Tan S, Liu M. Study on relationship between plasma matrix metalloproteinase-9 level and hemorrhagic transformation in acute ischemic stroke. 2005 doctoral paper of Sichan university.
19.	Kake W, Kaste M, Fieschi C, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous Alteplase in acute ischemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet, 1998; 352: 1245-1251.

1. 王家良. 臨床流行病學-臨床科研設計、衡量與評價. 第2版. 上海: 上海科學技術出版社; 2001. 297.
2. 劉建平. 非隨機研究的系統評價方法. 中國循證醫學, 2001; 1(4): 239～243.
3. 劉建平. 非隨機研究的系統評價方法. 中國循證醫學, 2002; 2(1): 44～48.
4. 談頌, 劉鳴. 血漿基質金屬蛋白酶-9與急性缺血性卒中出血轉化關系的初步研究. 2005屆四川大學博士論文.
5. Hacke W, Kaste M, Fieschi C, et al. for the ECASS Study Group. Intravenous thrombolysis with recombinant tissue plasminogen activator for actue hemispheric stroke. JAMA, 1995; 274(13): 1017-1025.
6. The National Institute of Neurological Disorders and Stroke rtPA Stroke Study Group. Tissue plasminogen activator for actue ischemic stroke. N Engl J Med, 1995; 333(24): 1581-1587.
7. The Multicenter Acute Stroke TrialEurope Study Group. Thrombolytic therapy with Streptokinasein acute ischemic stroke. N Engl J Med, 1996; 335(3): 145-150.
8. Rosenberg GA, Navratil M, Barone F, et al. Proteolytic casecade enzymes increase in focal cerebral ischemia in rat. J Cereb Blood Metab, 1996; 16(3): 360-366.
9. Gasche Y, Fujimura M, Morita- Fujimura Y, et al. Early appearance of activated matrix metalloprotienase-9 after focal cerebral ischemia in mice: a possible role in blood-brain barrier dysfuntion. J Cereb Blood Metab, 1999; 19(9): 1020-1028.
10. Wang JL. Clinical epidemiology-design, weigh, and evaluation of clinical research. Edi 2. Shanghai: Shanghai Publishing Company of Science and Technology; 2001. 297.
11. Liu JP. Method to systematic reviews of non-RCT. Chinese Journal of Evidence-Based Medicine, 2001; 1(4): 239-243.
12. Liu JP. Method to systematic reviews of non-RCT. Chinese Journal of Evidence-Based Medicine, 2002; 2(1): 44-48.
13. Castellanos M, Leila R, Serena J, et al. Plasma Cellular-Fibronectin Concentration Predicts Hemorrhagic Transformation After Thrombolytic Therapy in Acute Ischemic Stroke. Stroke, 2004; 35(7): 1671-1676.
14. Montaner J, Molina CA, Monasterio J, et al. Matrix Metalloproteinase-9 Pretreatment Level Predicts Intracranial Hemorrhagic Complications After Thrombolysis in Human Stroke. Circulation, 2003; 107(4): 598-603.
15. Montaner J, Fernández-Cadenas I, Molina CA, et al. Safety Profile of Tissue Plasminogen Activator Treatment Among Stroke Patients Carrying a Common Polymorphism (C-1562T) in the Promoter Region of the Matrix Metalloproteinase-9 Gene. Stroke, 2003; 34(12): 2851-2855.
16. Montaner J, Alvarez-Sabín J, Molina CA, et al. Matrix Metalloproteinase Expression Is Related to Hemorrhagic Transformation After Cardioembolic Stroke. Stroke, 2001; 32(12): 2762-2767.
17. Castellanos M, Leira R, Serena J, et al. Plasma Metalloproteinase-9 Concentration Predicts Hemorrhagic Transformation in Acute Ischemic Stroke. Stroke, 2003; 34(1): 40-46.
18. Tan S, Liu M. Study on relationship between plasma matrix metalloproteinase-9 level and hemorrhagic transformation in acute ischemic stroke. 2005 doctoral paper of Sichan university.
19. Kake W, Kaste M, Fieschi C, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous Alteplase in acute ischemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet, 1998; 352: 1245-1251.

《中國循證醫學雜志》

血漿基質金屬蛋白酶-9與缺血性卒中出血轉化關系的系統評價

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《中國循證醫學雜志》

血漿基質金屬蛋白酶-9與缺血性卒中出血轉化關系的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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