血清基质金属蛋白酶9预测大血管闭塞性脑卒中患者机械取栓术后出血转化的临床研究  

Clinical study of serum MMP-9 in predicting bleeding transformation in large vessel occlusive stroke patients after mechanical thrombectomy

作　　者：王丹[1] 王功锦 赵学渊 张晶 Wang Dan;Wang Gongjin;Zhao Xueyuan;Zhang Jing(Department of Neurology,Zhongxiang Hospital,People’s Hospital of Wuhan University,Zhongxiang 131900,Hebei Province,China)

机构地区：[1]武汉大学人民医院钟祥医院神经内科,431900 [2]华中科技大学同济医学院附属梨园医院神经内科

出　　处：《中华老年心脑血管病杂志》2023年第7期720-724,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：湖北省卫生健康委科研项目(WJ2019Q011)。

摘　　要：目的分析行机械取栓术的大血管闭塞性脑卒中患者血清基质金属蛋白酶9(MMP-9)水平与出血转化(HT)及预后的相关性。方法选择2019年7月至2022年2月武汉大学人民医院钟祥医院神经内科接受治疗的急性缺血性脑卒中(AIS)伴颈内动脉或大脑中动脉闭塞患者141例,分为HT组30例和非HT组111例。采用酶联免疫吸附法检测患者入院时及入院6、12、24、48h血清MMP-9水平。随访记录AIS患者机械取栓术后恶性脑水肿、神经功能恶化及预后。结果AIS患者入院6h血清MMP-9水平到达峰值,明显高于入院时,随后逐渐降低(P<0.01)。HT组入院时和入院6h血清MMP-9水平明显高于非HT组[(656.63±218.87)μg/Lvs(303.47±102.93)μg/L,P<0.01;(678.55±272.88)μg/Lvs(452.90±193.17)μg/L,P<0.01]。入院时血清MMP-9水平预测AIS患者机械取栓术后发生HT的曲线下面积为0.963。logistic回归分析显示,基线血清MMP-9≥300.91μg/L是AIS患者机械取栓术后发生HT的独立危险因素(P<0.05)。恶性脑水肿患者入院时和入院6h血清MMP-9水平明显高于无恶性脑水肿患者[(654.68±233.40)μg/Lvs(363.95±177.51)μg/L,P<0.01;(723.83±235.99)μg/Lvs(481.77±212.91)μg/L,P<0.01]。且AIS患者入院1周内美国国立卫生研究院卒中量表评分增加值、3个月改良的Rankin量表评分均与基线血清MMP-9水平呈正相关(r=0.510,r=0.227,P<0.05)。结论血清MMP-9有望成为临床识别机械取栓术后HT高风险患者的潜在生物标志物。Objective To analyze the correlation of serum MMP-9 level with hemorrhagic transformation(HT)and prognosis in patients with large vessel occlusion stroke undergoing mechanical thrombectomy.Methods A total of 141 patients suffering from acute ischemic stroke(AIS)with internal carotid artery or middle cerebral artery occlusion admitted in Department of Neurology of Zhongxiang Hospital from July 2019 to February 2022 were recruited and divided into HT group(n=30)and non-HT group(n=111).Serum MMP-9 level was detected with ELISA at admission and in 6,12,24 and 48 h after admission.The incidence of malignant brain edema,neurological deterioration and prognosis of AIS patients after mechanical thrombectomy were recorded during follow-up.Results The serum MMP-9 level reached the peak at 6 h after admission in the AIS patients,obviously higher than the baseline level at admission,and then decreased gradually(P<0.01).The serum MMP-9 levels at admission and 6 h after admission were significantly higher in the HT group than the non-HT group(656.63±218.87μg/L vs 303.47±102.93μg/L,P<0.01;678.55±272.88μg/L vs 452.90±193.17μg/L,P<0.01).The AUC value of serum MMP-9 at admission in predicting HT in AIS patients after mechanical thrombectomy was 0.963.Logistic regression analysis indicated that the baseline serum MMP-9≥300.91μg/L was an independent risk factor for HT in AIS patients after mechanical thrombectomy(P<0.05).The serum MMP-9 levels at admission and at 6 h after admission were notably higher in the patients with malignant brain edema than those without malignant brain edema(654.68±233.40μg/L vs 363.95±177.51μg/L,P<0.01;723.83±235.99μg/L vs 481.77±212.91μg/L,P<0.01).NIHSS score increment within 1 week after admission and average mRS score at 3 months were positively correlated with baseline serum MMP-9 level(r=0.510,r=0.227,P<0.05).Conclusion Serum MMP-9 may be a potential biomarker for identifying high-risk HT patients after mechanical thrombectomy.

关 键 词：卒中 球囊取栓术 基质金属蛋白酶9 脑出血 预后 预测 数据相关性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]