engleski

Matrix metalloproteinases in acute stroke

Background and Purpose-We aimed to correlate the serum levels of matrix metalloproteinase's (MMPs) and their natural inhibitors (TIMPs) in acute faze of different stroke type and to study its influence on clinical outcome. Methods-We measured serum levels of MMPs and TIMPs in 140 consecutive patients entering the Stroke unit by enzyme-linked immunosorbent assay (Biotrak Amersham) and compared with the values obtained in 120 healthy control subjects. Blood samples were drawn within the first 24 hours after symptom onset. Results - In patients the concentration of MMP-2 (p< 0.001) and MMP-2/TIMP2 ratio (p< 0.001) were lower, whereas TIMP-2 (p<0.001) was higher than in controls. The MMP-9 levels and MMP-9/TIMP-1 ratio where higher in patients with thromboembolic (n=79) (p=0.003 and p=0.016) than in patients with lacunar stroke (n=53) and healthy control (n=120) (p=0.005, p=0.0070). In patients with thromboembolic stroke NIHSS correlated with MMP-2/TIMP-2 ratio (r=0.237, p=0.037), and Barthel´s index negatively correlated with MMP-9 levels (r=-0.254, p=0.026). In lacunar stroke patients NIHSS was negatively correlate with MMP-2 levels (r=-0.406, p=0.003), and Barthel´s index with TIMP-1 levels (r=-0.398, p=0.003). In thromboembolic stroke ROC analysis shows that for MMP-9 the areas under the curve (AUC) were 0.617 (95%CI, 0.545-0.685), cut off value >661.5 ng/mL and for MMP-9/TIMP-1 ratio were 0.611 (95%CI, 0.539-0.679), >0.365 respectively. In lacunar stroke ROC analysis for MMP-9 shows: AUC=0.561 (95%CI, 0.484-0.636), cut off value <278 ng/mL and for MMP-9/TIMP-1 ratio AUC=0.521 (95%CI, 0.444-0.597), <0.132 respectively. Conclusions - High MMP-9 and TIMP-1 levels in the acute phase of thromboembolic stroke can predict the outcome, and correlate well with NIHSS and Barthel. The MMP-9 level and MMP9/TIMP-1 ratio can be helpful to distinguish thromboembolic from lacunar stroke.

MMPs; TIMPs; acute phase; stroke

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