血清基质金属蛋白酶-9、神经丝蛋白轻链水平对首发缺血性脑卒中后患者认知功能障碍的预测价值  

Predictive value of serum matrix metalloproteinase-9 and neurofilament light chain levels for cognitive impairment patients after first-onset ischemic stroke

作　　者：单娜 赵丽[1] 林晓东[1] SHAN Na;ZHAO Li;LIN Xiaodong(Department of Neurology,the Second Hospital of Qinhuangdao in Hebei Province,Qinhuangdao,Hebei,066600)

机构地区：[1]河北省秦皇岛市第二医院神经内科,河北秦皇岛066600

出　　处：《实用临床医药杂志》2023年第8期67-70,90,共5页Journal of Clinical Medicine in Practice

基　　金：2020年河北省秦皇岛市科学技术研究与发展计划项目(202004A100)。

摘　　要：目的探讨血清基质金属蛋白酶-9(MMP-9)、神经丝蛋白轻链(NFL)对首发急性缺血性脑卒中(AIS)患者卒中后认知障碍(PSCI)的预测价值。方法选取首发AIS患者80例,根据卒中6个月后蒙特利尔认知评估量表(MoCA)评分将患者分为PSCI组(MoCA评分<26分)与非PSCI组(MoCA评分≥26分)。比较2组入院时血清MMP-9、NFL水平;分析MMP-9、NFL水平与MoCA评分的相关性;采用Logistic回归模型确定PSCI的危险因素;采用受试者工作特征(ROC)曲线评估MMP-9、NFL水平对PSCI的预测效能。结果PSCI组血清MMP-9、NFL水平高于非PSCI组,差异有统计学意义(P<0.05)。Pearson相关分析显示,患者入院时MMP-9、NFL水平均与出院6个月后的MoCA评分呈负相关(r=-0.457、-0.512,P<0.05)。Logistic回归分析显示,年龄(OR=1.468)、MMP-9水平(OR=1.694)、NFL水平(OR=1.802)是首发AIS患者发生PSCI的独立影响因素(P<0.05)。ROC曲线分析显示,入院时MMP-9、NFL水平预测PSCI发生的曲线下面积(AUC)分别为0.805、0.833;二者联合预测的AUC为0.905,相比单一指标均增大,差异有统计学意义(P<0.05)。结论MMP-9、NFL均可作为首发AIS患者PSCI发生的预测指标,二者联合评估可进一步提高预测效能。Objective To investigate the predictive value of serum matrix metalloproteinase-9(MMP-9)and neurofilament light chain(NFL)for post-stroke cognitive impairment(PSCI)in patients with first-onset acute ischemic stroke(AIS).Methods Eighty patients with AIS were selected.According to Montreal Cognitive Assessment(MoCA)score after 6 months of stroke,they were divided into PSCI group(MoCA score<26)and non-PSCI group(MoCA score≥26).The serum levels of MMP-9 and NFL were compared between the two groups on admission;the correlations of MMP-9 and NFL level with MoCA score were analyzed;the Logistic regression model was used to determine the risk factors of PSCI;the receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of MMP-9 and NFL levels on PSCI.Results The serum levels of MMP-9 and NFL in the PSCI group were significantly higher than those in the non-PSCI group(P<0.05).Pearson correlation analysis showed that MMP-9 and NFL levels at admission were negatively correlated with MoCA scores 6 months after discharge(r=-0.457,-0.512;P<0.05).Logistic regression analysis showed that age(OR=1.468),MMP-9 level(OR=1.694)and NFL level(OR=1.802)were independent influencing factors for PSCI in patients with first-ever AIS(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of MMP-9 and NFL level predicting the occurrence of PSCI at admission were 0.805 and 0.833,respectively;the AUC predicted by the combination of the two indexes was 0.905,which was higher than that of a single index,and the difference was statistically significant(P<0.05).Conclusion Both MMP-9 and NFL can be used as predictors of PSCI occurrence in patients with first-onset AIS,and their combined evaluation can further improve the predictive efficacy.

关 键 词：急性缺血性脑卒中 卒中后认知障碍 基质金属蛋白酶-9 神经丝蛋白轻链 

分 类 号：R743[医药卫生—神经病学与精神病学] R446[医药卫生—临床医学]