基质金属蛋白酶9和中性粒细胞/淋巴细胞比值预测自发性脑出血患者的迟发性血肿周围脑水肿  

Matrix metalloproteinase-9 and neutrophil to lymphocyte ratio predict delayed perihematomal edema in patients with spontaneous intracerebral hemorrhage

作　　者：顾双双[1] 沙杜鹃[1] 高凤娟[1] 蒋云飞 王军[1] 李瑾[1] Gu Shuangshuang;Sha Dujuan;Gao Fengjuan;Jiang Yunfei;Wang Jun;Li Jin(Emergency Department,Nanjing Drum Tower Hospital Affiliated to Nanjing 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,南京210008

出　　处：《国际脑血管病杂志》2021年第2期114-119,共6页International Journal of Cerebrovascular Diseases

基　　金：南京市医学科技发展项目(YKK16074)。

摘　　要：目的探讨外周血基质金属蛋白酶9(matrix metalloproteinase-9,MMP-9)和中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)对自发性脑出血(spontaneous intracerebral hemorrhage,sICH)后迟发性血肿周围脑水肿(delayed perihematomal edema,dPHE)的预测价值。方法回顾性纳入2018年1月至2020年6月期间南京大学医学院附属鼓楼医院收治的sICH患者。在发病24 h内检测血清MMP-9水平、外周血细胞计数并计算NLR。dPHE定义为sICH发病后10~21 d绝对水肿体积较5~9 d时增加3 ml。比较dPHE组与非dPHE组人口统计学以及基线临床和影像学资料。应用多变量logistic回归分析确定dPHE的独立预测因素。应用受试者工作特征(receiver operating characteristic,ROC)曲线评估MMP-9和NLR对dPHE的预测价值。结果共纳入195例sICH患者,年龄(61.88±10.60)岁,男性148例(75.9%);dPHE组53例(27.2%),非dPHE组142例(72.8%)。单变量分析显示,dPHE组年龄、基线血肿体积、基线美国国立卫生研究院卒中量表评分、空腹血糖、超敏C反应蛋白、MMP-9、中性粒细胞计数、NLR以及不规则血肿比例均显著高于非dPHE组(P均<0.05)。多变量logistic回归分析显示,在校正混杂因素后,MMP-9较高[优势比(odds ratio,OR)4.291,95%置信区间(confidence interval,CI)2.041~6.590;P=0.007]和NLR较高(OR 2.530,95%CI 1.157~4.022;P=0.011)均为dPHE的独立预测因素。ROC曲线分析显示,MMP-9预测dPHE的曲线下面积为0.819(95%CI 0.756~0.884;P<0.001),最佳截断值为164.0μg/L,对应的敏感性和特异性分别为86.79%和66.90%;NLR预测dPHE的曲线下面积为0.788(95%CI 0.719~0.856;P<0.001),最佳截断值为5.683,对应的敏感性和特异性分别为77.36%和71.13%。结论基线MMP-9和NLR较高的sICH患者更易发生dPHE,入院后早期检测外周血MMP-9和NLR可预测dPHE。Objective To investigate the predictive value of matrix metalloproteinase-9(MMP-9)and neutrophil to lymphocyte ratio(NLR)in delayed perihematomal edema(dPHE)after spontaneous intracerebral hemorrhage(sICH).Methods Patients with sICH admitted to Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School within 24 h of onset from January 2018 to June 2020 were enrolled retrospectively.Serum MMP-9 levels and peripheral blood cell counts were detected,and NLR were calculated within 24 h of onset.dPHE was defined as an increase of 3 ml in absolute edema volume at 10-21 d after onset of sICH compared with that at 5-9 d.The demographic and baseline clinical and imaging data of the dPHE group and the non-dPHE group were compared.Multivariate logistic regression analysis was used to identify the independent predictors of dPHE.The receiver operating characteristic(ROC)curve was used to evaluate the predictive values of MMP-9 and NLR for dPHE.Results A total of 195 patients with sICH(61.88±10.60 years old)were enrolled in the study.One hundred and forty-eight patients were males(75.9%).There were 53 patients(27.2%)in the dPHE group and 142(72.8%)in the non-dPHE group.Univariate analysis showed that age,baseline hematoma volume,baseline National Institutes of Health Stroke Scale score,fasting blood glucose,high-sensitivity C-reactive protein,MMP-9,neutrophil count,NLR and the proportion of irregular hematoma in the dPHE group were significantly higher than those in the non-dPHE group(all P<0.05).Multivariate logistic regression analysis showed that after adjusting for confounding factors,higher MMP-9(odds ratio[OR]4.291,95%confidence interval[CI]2.041-6.590;P=0.007)and higher NLR(OR 2.530,95%CI 1.157-4.022;P=0.011)were all the independent predictors of dPHE.ROC curve analysis showed that the area under the curve of MMP-9 for predicting dPHE was 0.819(95%CI 0.756-0.884;P<0.001),the optimal cut-off value was 164.0μg/L,and the sensitivity and specificity were 86.79%and 66.90%respectively.The area under the cu

关 键 词：脑出血 血肿 脑水肿 时间因素 基质金属蛋白酶9 中性粒细胞 淋巴细胞 危险因素 

分 类 号：R743.34[医药卫生—神经病学与精神病学]