血清和肽素、MMP-9水平对动脉瘤性蛛网膜下腔出血患者手术治疗预后的预测价值  

Predictive value of serum copeptin and MMP-9 levels on surgical treatment of patients with aneurysmal subarachnoid hemorrhage

作　　者：彭浩[1] 陈健龙[1] 刘朝晖[1] 蔡仁端[1] 王义彪[1] Peng Hao;Chen Jianlong;Liu Chaohui;Cai Renrui;Wang Yibiao(Department of Neurosurgery, Hainan People's Hospital/Hainan Hospital Affiliated to Hainan Medical College, Hainan Province, Haikou 570311,China)

机构地区：[1]海南省人民医院/海南医学院附属海南医院神经外科,海口570311

出　　处：《疑难病杂志》2020年第9期874-879,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：海南省科技发展计划资助项目(ZDYF2018114)。

摘　　要：目的分析血清和肽素(copeptin)、基质金属蛋白酶-9(MMP-9)水平与动脉瘤性蛛网膜下腔出血(aSAH)患者手术治疗转归的关系及其预测价值。方法选择2017年2月—2019年2月海南省人民医院神经外科收治的aSAH患者107例,均接受手术治疗,根据术后转归情况将患者分为转归不良组(33例)和转归良好组(74例)。比较2组患者临床资料及血清和肽素、MMP-9水平。多元Logistic回归分析影响aSAH患者术后转归不良的危险因素,受试者工作特征曲线(ROC)分析血清和肽素、MMP-9预测aSAH患者术后转归的价值。结果转归不良组WFNS分级Ⅲ~Ⅴ级、Hunt-Hess分级Ⅲ~Ⅴ级、改良Fisher分级Ⅲ~Ⅴ级、并发迟发性脑缺血、并发脑出血、入院至手术时间≥72 h的患者比例及入院收缩压、血清和肽素、MMP-9水平高于转归良好组(χ^2/t/P=6.119/0.013、5.316/0.021、10.019/0.002、5.455/0.020、4.503/0.034、4.093/0.043、6.737/0.000、15.256/0.000、10.767/0.000)。多元Logistic回归分析结果显示,Hunt-Hess分级Ⅲ~Ⅴ级、并发迟发性脑缺血、入院至手术时间≥72 h及血清和肽素、MMP-9水平升高是影响aSAH患者术后转归不良的危险因素[1.582(95%CI 1.113~2.249)、1.857(95%CI 1.192~2.894)、1.670(95%CI 1.117~2.497)、2.547(95%CI 1.524~4.258)、3.102(95%CI 1.659~5.800),P均<0.05]。ROC分析结果显示,血清和肽素、MMP-9水平、MMP-9联合和肽素预测aSAH患者术后转归不良的曲线下面积(AUC)为0.734、0.703、0.954,,敏感度分别为66.67%、81.82%、90.91%,特异度分别为71.62%、50.00%、93.24%,约登指数分别为0.383、0.318、0.841。结论Hunt-Hess分级Ⅲ~Ⅴ级、并发迟发性脑缺血、入院至手术时间≥72 h及血清和肽素、MMP-9水平升高与aSAH患者术后转归不良密切相关,血清和肽素、MMP-9可作为aSAH患者术后转归预测的辅助血清学指标。Objective To analyze the relationship between serum copeptin and matrix metalloproteinase-9(MMP-9)levels and the prognosis of patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 107 patients with aSAH admitted to the Department of Neurosurgery of Hainan Provincial People's Hospital from February 2017 to February 2019 were selected.All patients received surgical treatment.According to the postoperative outcomes,the patients were divided into poor outcome group(33 cases)and good outcome group(74 cases).The clinical data,serum copeptin and MMP-9 levels were compared between the two groups.Multivariate logistic regression analysis was used to analyze the risk factors of poor outcome in patients with aSAH.Receiver operating characteristic curve(ROC)was used to analyze the value of serum copeptin and MMP-9 in predicting the postoperative outcome of patients with aSAH.Results The proportion of patients in the poor outcome group with WFNS gradeⅢ-Ⅴ,Hunt Hess gradeⅢ-Ⅴ,modified Fisher gradeⅢ-Ⅴ,complicated with delayed cerebral ischemia,complicated with cerebral hemorrhage,and the time from hospital admission to operation≥72 hours and The levels of admission systolic blood pressure,serum and copeptin,and MMP-9 were higher than those in the good outcome group(χ^2/t/P=6.119/0.013,5.316/0.021,10.019/0.002,5.455/0.020,4.503/0.034,4.093/0.043,6.737/0.000,15.256/0.000,10.767/0.000).The results of multiple logistic regression analysis showed that Hunt Hess gradeⅢ-Ⅴ,complicated delayed cerebral ischemia,time from hospital admission to operation≥72 h,and elevated serum levels of copeptin and MMP-9 affect the poor postoperative outcome of aSAH patients Risk factors of[1.582(95%CI 1.113-2.249),1.857(95%CI 1.192-2.894),1.670(95%CI 1.117-2.497),2.547(95%CI 1.524-4.258),3.102(95%CI 1.659-5.800),all P<0.05].ROC analysis results showed that the area under the curve(AUC)of serum and copeptin,MMP-9 levels,MMP-9 combination and copeptin predicting poor postoperative outcome of aSAH patients were 0.734

关 键 词：和肽素 基质金属蛋白酶-9 动脉瘤性蛛网膜下腔出血 术后转归 预测价值 

分 类 号：R74[医药卫生—神经病学与精神病学]