血清MMP-8、CHE、CyPA水平联合预测急性脑梗死患者介入取栓术后预后不良的价值  

Value of Serum MMP-8,CHE and CyPA Levels in Predicting Poor Prognosis After Interventional Thrombectomy in Patients with Acute Cerebral Infarction

作　　者：张昊 高立功 于广周 黄一苇 梁浩 张永宁 白波[2] ZHANG Hao;GAO Ligong;YU Guangzhou;HUANG Yiwei;LIANG Hao;ZHANG Yongning;BAI Bo(The Third Departments of Neurology,Zhumadian Central Hospital,Zhumadian 463000,China;Department of Neurology,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]驻马店市中心医院神内三科,河南驻马店463000 [2]山西医科大学第二医院神经内科,山西太原030001

出　　处：《河南医学研究》2023年第19期3535-3539,共5页Henan Medical Research

基　　金：山西省青年科学研究项目(20210302124692)。

摘　　要：目的探讨血清基质金属蛋白酶8(MMP-8)、胆碱酯酶(CHE)、亲环素A(CyPA)水平联合预测急性脑梗死(ACI)患者介入取栓术后预后不良的价值。方法选取2019年9月至2021年9月驻马店市中心医院收治的拟行介入取栓术治疗的169例ACI患者为观察组,另选取158例同期健康体检者为对照组,两组均行血清MMP-8、CHE、CyPA水平检测并进行对比。出院后随访3个月,根据改良Rankin量表(mRS)评分将ACI患者分为预后良好组(≤2分)与预后不良组(>2分),比较两组血清MMP-8、CHE、CyPA水平,采用多因素logistic回归分析ACI患者介入取栓术后预后不良的影响因素,采用受试者工作特征(ROC)曲线分析各血清指标单项及联合对ACI患者介入取栓术后预后不良的预测价值。结果观察组血清MMP-8、CyPA水平高于对照组,CHE水平低于对照组(P<0.05);随访3个月,预后良好106例,预后不良63例,预后不良发生率为37.27%(63/169)。预后不良组血清MMP-8、CyPA水平高于预后良好组,CHE水平低于预后良好组(P<0.05)。多因素logistic回归分析显示入院时美国国立卫生院卒中量表(NIHSS)评分高、发病至手术时间、术后24 h内症状性脑出血、血清MMP-8高表达及CyPA高表达均是影响ACI介入取栓术后预后不良的独立危险因素(P<0.05),入院时Alberta卒中项目早期CT评分(ASPECTs)评分高、侧支循环良好、血管成功再通及CHE高表达均是预后良好的独立保护因素(P<0.05)。ROC曲线显示,MMP-8、CHE、CyPA联合预测ACI介入取栓术后预后不良的灵敏度均高于单独预测(P<0.05),曲线下面积(AUC)也高于单独预测(P<0.05),特异度与单独预测比较差异无统计学意义(P>0.05)。结论ACI患者血清MMP-8、CyPA水平异常升高,而血清CHE异常降低,且三者异常变化均与ACI患者介入取栓术后预后不良密切相关,三者联合对ACI患者介入取栓术后预后不良具有良好预测价值。Objective To investigate the value of serum matrix metalloproteinase-8(MMP-8),cholinesterase(CHE)and cyclophilin A(CyPA)levels in predicting the poor prognosis of patients with acute cerebral infarction after interventional thrombectomy.Methods A total of 169 patients with ACI who were planned to undergo interventional thrombectomy in Zhumadian Central Hospital from September 2019 to September 2021 were selected as the observation group,another 158 cases of physical examination in the same period were selected as the control group.The levels of serum MMP-8,CHE and CyPA were detected and compared between the two groups.Follow up for 3 months after discharge,ACI patients were divided into good prognosis group(≤2 points)and poor prognosis group(>2 points)according to the modified Rankin scale(mRS)score,and the levels of serum MMP-8,CHE and CyPA were compared between the two groups.Multivariate logistic regression analysis was used to analyze the influencing factors of poor prognosis after interventional thrombectomy in patients with ACI,and the predictive values of single and combination of each serum indexes on poor prognosis after interventional thrombectomy in patients with ACI were analyzed by receiver operating characteristic(ROC)curve.Results The levels of serum MMP-8 and CyPA in the observation group were higher than those in the control group,and the level of CHE was lower than those in the control group(P<0.05).After 3 months follow-up,106 cases had a good prognosis and 63 cases had a poor prognosis,and the incidence rate of poor prognosis was 37.27%(63/169).The levels of serum MMP-8 and CyPA in the poor prognosis group were higher than those in the good prognosis group,and the level of CHE was lower than those in the good prognosis group(P<0.05).Multivariate logistic regression analysis showed that the high National Institutes of Health stroke scale(NIHSS)score at admission,time from onset to operation,symptomatic intracerebralhemorrhage within 24 hours after operation,high expression of serum MMP-8 and

关 键 词：急性脑梗死 基质金属蛋白酶8 胆碱酯酶 亲环素A 介入取栓术 预后不良 

分 类 号：R743.3[医药卫生—神经病学与精神病学]