血清基质金属蛋白酶9和铁蛋白对急性缺血性卒中出血性转化的预测价值  

Predictive values of serum matrix metalloproteinase-9 and ferritin for hemorrhagic transformation after acute ischemic stroke

作　　者：王芳[1] 倪杰[1] 周祎[1] 蒋敏[1] 沙杜鹃[1] Wang Fang;Ni Jie;Zhou Yi;Jiang Min;Sha Dujuan(Department of Emergency Medicine, the Affiliatled Drum Tower Hospital of Nanfing University Medical School, Nanjing, 210008, China)

机构地区：[1]南京大学医学院附属鼓楼医院急诊科,210008

出　　处：《国际脑血管病杂志》2017年第11期1013-1017,共5页International Journal of Cerebrovascular Diseases

摘　　要：目的 探讨血清基质金属蛋白酶9（matrix metalloproteinase-9, MMP-9）和铁蛋白（serum ferritin, SF）水平对急性缺血性卒中出血性转化（hemorrhagic transformation, HT）的预测价值。 方法 选取发病24 h内的首次急性缺血性卒中患者，收集人口统计学和临床资料，检测MMP-9和SF水平。对HT组与非HT组人口统计学、临床资料和实验室检查结果进行比较，采用多变量logistic回归分析确定HT的独立危险因素，采用受试者工作特征（receiver operating characteristic, ROC）曲线分析确定MMP-9和SF对HT的预测价值。 结果 共纳入150例患者，平均年龄（67.01±9.11）岁，男性65例（43.33%）；HT组32例（21.33%），非HT组118例（78.67%）。单变量分析显示，HT组MMP-9[（161.19±36.86）μg/L对（100.18±36.70）μg/L；t＝8.333，P〈0.001]和SF水平[195.50（188.25～201.00）μg/L对175.00 （165.00～189.25）μg/L；Z＝4.891，P〈0.001]显著高于非HT组。多变量logistic回归分析显示，糖尿病[优势比（odds ratio, OR）2.273，95%可信区间（confidence interval, CI）1.019～5.070；P＝0.047]、心房颤动（OR 4.846，95% CI 1.934～12.146；P＝0.001）、MMP-9（OR 3.176，95% CI 1.842～5.479；P〈0.001）、高敏C反应蛋白（OR 2.243，95% CI 1.015～4.954；P＝0.045）和SF（OR 2.722，95% CI 1.586～4.672；P〈0.001）是HT的独立危险因素。ROC曲线分析显示，MMP-9（曲线下面积0.904，95% CI 0.851～0.957）和SF（曲线下面积0.776，95% CI 0.684～0.869）对HT具有显著的预测价值。当MMP-9截断值为133 μg/L时，敏感性和特异性分别为84.4%和15.3%；当SF截断值为187.5 μg/L时，敏感性和特异性分别为78.1%和27.1%。 结论 急性缺血性卒中HT患者血清MMP-9和SF水平显著升高，早期检测血清MMP-9和SF水平有助于预测HT风险。Objective To investigate the predictive values of matrix metalloproteinase-9 （MMP-9） and serum ferritin （SF） for hemorrhagic transformation （HT） after acute ischemic stroke. Methods The patients with first-ever acute ischemic stroke within 24 h of onset were selected. The demographic and clinical data were collected. The MMP-9 and SF levels were detected. The demographic and clinical data and laboratory results were compared between a HT group and a non-HT group. Multivariable logistic regression analysis was used to determine the independent risk factor for HT. The receiver operating characteristic （ROC） curve was used to identify the predictive values of MMP-9 and SF for HT. Results A total of 150 patients were enrolled, their mean age was 67.01±9.11 years, including 65 males （43.33%）. There were 32 patients （21.33%） in the HT group and 118 （78.67%） in the non-HT group. Univariate analysis showed that MMP-9 （161.19±36.86 μg/L vs. 100.18±36.70 μg/L; t=8.333, P〈0.001） and SF （195.50 [188.25-201.00]μg/L vs. 175.00[165.00-189.25]μg/L; Z=4.891, P〈0.001） in the HT group were significantly higher than those in the non-HT group. Multivariable logistic regression analysis showed that diabetes （odds ratio [OR] 2.273, 95% confidence interval [CI]1.019-5.070; P=0.047）, atrial fibrillation （OR 4.846, 95% CI 1.934-12.146; P=0.001）, MMP-9 （OR 3.176, 95% CI 1.842-5.479; P〈0.001）, hypersensitivity C reactive protein （OR 2.243, 95% CI 1.015-4.954; P=0.045）, and SF （OR 2.722, 95% CI 1.586-4.672; P〈0.001） were the independent risk factors for HT. The ROC curve analysis showed that MMP-9 （area under curve 0.904, 95% CI 0.851-0.957） and SF （area under curve 0.776, 95% CI 0.684-0.869） had significant predictive values for HT. When the cut-off value of MMP-9 was 133 μg/L, the sensitivity and specificity were 84.4% and 15.3%, respectively. When the cut-off value of SF was 187.5 μg/L, the sensitivity and specificity were 78.1% and 27.1%, respectively.

关 键 词：卒中 脑缺血 脑出血 基质金属蛋白酶9 铁蛋白类 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]