颗粒蛋白前体、基质金属蛋白酶-9及入院时美国国立卫生研究院卒中量表评分对脑梗死病人出血转化的预测价值  

Predictive value of PGRN, MMP-9 and NIHSS scores at admission for hemorrhagic transformation in patients with cerebral infarction

作　　者：姚丽娜[1] 时伟 孙喜燕[1] 马艳 张立娜 YAO Lina;SHI Wei;SUN Xiyan;MA Yan;ZHANG Lina(Department of Geriatrics,the Second Central Hospital of Baoding,Baoding,Hebei 072750,China)

机构地区：[1]保定市第二中心医院老年病科,河北保定072750

出　　处：《安徽医药》2021年第5期966-970,共5页Anhui Medical and Pharmaceutical Journal

基　　金：河北省医药卫生科技项目(13010520171147)。

摘　　要：目的分析颗粒蛋白前体(PGRN)、基质金属蛋白酶-9(MMP-9)及入院时美国国立卫生研究院卒中量表(NIHSS)评分对脑梗死病人溶栓后出血转化的预测价值。方法回顾性分析保定市第二中心医院2016年3月至2019年3月收治的94例急性脑梗死并接受急诊溶栓治疗病人的临床资料。根据溶栓治疗后是否发生出血性转化将病人分为出血组(n=30)和未出血组(n=64),收集病人的临床资料,对溶栓后发生出血性转化的危险因素进行分析,比较两组入院时和溶栓治疗15 d后PGRN、MMP-9、NIHSS评分变化情况,并利用受试者工作特征曲线(ROC)评价PGRN、MMP-9及入院时NIHSS评分对脑梗死病人出血转化的预测价值。结果单因素分析结果显示,两组病人的梗死面积、溶栓时间窗、病发前抗凝药物使用、随机血糖值、NIHSS评分、PGRN水平、MMP-9水平比较均差异有统计学意义(P<0.05);多因素logistic回归分析结果显示:溶栓时间窗>3.5 h、随机血糖值>8 mmol/L、NIHSS评分>12分、PGRN水平>65μg/L、MMP-9≥110 mg/L均是脑梗死病人出血转化的独立危险因素(P<0.05);出血组入院时及溶栓治疗后15 d时PGRN、MMP-9水平及NIHSS评分均明显高于未出血组(P<0.05);ROC结果显示:入院时PGRN、MMP-9及NIHSS评分预测脑梗死病人出血转化的AUC分别为0.819、0.851、0.791,95%CI分别为0.727~0.912、0.752~0.950、0.684~0.898,Cut off值分别为64.905μg/L、106.51 mg/L、11.85分。结论PGRN、MMP-9及NIHSS评分均是脑梗死病人出血转化的危险因素,脑梗死早期检测PGRN、MMP-9及NIHSS评分对预测脑梗死出血转化有一定的参考价值。Objective To analyze predictive value of progranulin(PGRN),matrix metalloproteinase-9(MMP-9)and scores of National Institutes of Health Stroke Scale(NIHSS)on admission to hemorrhagic transformation(HT)in patients with cerebral infarction after thrombolysis.Methods The clinical data of 94 patients with acute cerebral infarction(ACI)who underwent emergency thrombolysis and were admitted to the Second Central Hospital of Baoding from March 2016 to March 2019 were analyzed retrospectively.According to presence or absence of HT after thrombolysis,they were divided into hemorrhage group(n=30)and non-hemorrhage group(n=64).The clinical data of patients were collected.The risk factors of HT after thrombolysis were analyzed.Changes in PGRN,MMP-9 and NIHSS scores at admission and after 15 d of thrombolysis were compared between the two groups.The receiver operating characteristic(ROC)curves were applied to evaluate predictive value of PGRN,MMP-9 and NIHSS scores at admission for HT in cerebral infarct patients.Results The results of univariate analysis showed that there were significant differences in infarct size,thrombolysis time-window,anticoagulants usage before onset,random blood glucose value,NIHSS score,levels of PGRN and MMP-9 between the two groups(P<0.05).The results of multivariate logistic regression analysis showed that thrombolysis time-window longer than 3.5h,random blood glucose value higher than 8 mmol/L,NIHSS score higher than 12 points,PGRN level higher than 65μg/L and MMP-9 not lower than110 mg/L were all independent risk factors of HT in patients with cerebral infarction(P<0.05).At admission and after 15d of thrombolysis,levels of PGRN and MMP-9,and NIHSS scores in hemorrhage group were significantly higher than those in non-hemorrhage group(P<0.05).ROC results showed that AUC,95%CI and Cut off values of PGRN,MMP-9 and NIHSS at admission for predicting HT in cerebral infarct patients were(0.819,0.851,0.791),(0.727-0.912,0.752-0.950,0.684-0.898)and(64.905μg/L,106.51 mg/L,11.85 points),respectively.Con

关 键 词：脑梗死 出血转化 颗粒蛋白前体 基质金属蛋白酶-9 美国国立卫生研究院卒中量表 

分 类 号：R743.3[医药卫生—神经病学与精神病学]