中老年脑小血管病患者影像学标志物与血清几丁质酶3样蛋白1、基质金属蛋白酶9水平变化的相关性  

Title correlation analysis of chitinase-3 like-protein-1, matrix metalloproteinase-9 and imaging markers in middle aged and elderly patients with cerebral small vessel disease

作　　者：汤茗 白宏英[1] 徐辉[1] Tang Ming;Bai Hongying;Xu hui(Department of Neurology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第二附属医院神经内科,郑州450000

出　　处：《中华老年医学杂志》2024年第3期297-303,共7页Chinese Journal of Geriatrics

基　　金：河南省医学科技攻关计划项目(LHGJ20190314)。

摘　　要：目的探讨中老年脑小血管病(CSVD)患者影像学标志物与血清几丁质酶3样蛋白1(YKL-40)、基质金属蛋白酶9(MMP-9)水平变化之间的相关性,明确CSVD的发生发展机制。方法病例对照研究,选取2020年12月至2022年11月在郑州大学第二附属医院神经内科就诊的CSVD患者130例、年龄匹配对照组20例,分别根据脑白质高信号(WMH)评分将CSVD患者分为WMH轻度组、WMH中度组、WMH重度组,血管周围间隙扩大(EPVS)评分分为EPVS轻度组、EPVS中度组、EPVS重度组,是否存在腔隙、微出血(CMBs)分为无腔隙组、有腔隙组以及无CMBs组、有CMBs组。收集患者的一般资料,用酶联免疫吸附试验测定患者血清YKL-40、MMP-9水平,并进行比较分析。结果评分后得到WMH重度组34例,EPVS重度组35例,有腔隙组90例,有CMBs组65例。WMH重度组与年龄对照组相比血清YKL-40水平、MMP-9水平差异有统计学意义(均P<0.05);EPVS重度组与年龄对照组相比血清YKL-40水平、MMP-9水平差异有统计学意义(均P<0.05)。血清YKL-40、MMP-9水平升高是WMH(OR=1.25,95%CI:0.164~0.289,P<0.05)(OR=1.13,95%CI:0.090~0.160,P<0.05)、EPVS(OR=1.05,95%CI:0.021~0.076,P<0.05)(OR=1.02,95%CI:0.006~0.026,P<0.05)严重程度的独立危险因素。有腔隙组与无腔隙组相比,血清YKL-40、MMP-9水平差异无统计学意义(P>0.05)。有CMBs组血清YKL-40、MMP-9水平较无CMBs组明显升高(均P<0.05)。ROC曲线显示YKL-40诊断CSVD的最佳截断点为0.38,曲线下面积0.669(95%CI:0.569~0.768,P<0.01),MMP-9诊断CSVD的最佳截断点为0.40,曲线下面积0.746(95%CI:0.644~0.848,P<0.01)。结论中老年CSVD患者的血清YKL-40、MMP-9水平变化与多种影像学标志物相关,可能参与了CSVD的发生发展,有助于CSVD的早期诊断,或可为其干预治疗提供思路。Objective This study aimed to investigate the correlation between serum chitinase-3 like-protein-1(YKL-40),matrix metalloproteinase-9(MMP-9),and imaging markers in middle-aged and elderly patients with cerebral small vessel disease(CSVD).It also sought to elucidate the mechanism underlying the onset and development of CSVD.Methods A case-control study was conducted with 130 CSVD patients and 20 age-matched controls admitted to the Department of Neurology of the Second Affiliated Hospital of Zhengzhou University between December 2020 and November 2022.Based on their white matter hyperintensity(WMH)and enlarged perivascular spaces(EPVS)scores,CSVD patients were categorized into mild,moderate,and severe groups.Cerebral microbleeds(CMBs)were classified into non-lacunar,lacunar,non-CMBs,and CMBs groups.Patients'general data were collected,and serum levels of YKL-40 and MMP-9 were measured using ELISA.Results The results showed 34 cases in the severe WMH group,35 cases in the EPVS severe group,90 cases in the group with lacunar and 65 cases in the group with CMBs.Statistically significant differences(both P<0.05)in serum YKL-40 and MMP-9 in WMH severe groups compared to age control group.Statistically significant differences(both P<0.05)in serum YKL-40 and MMP-9 in EPVS severe groups compared to age control group.The increase of serum YKL-40 and MMP-9 levels was an independent risk factor for the severity of WMH(OR=1.25,95%CI:0.164-0.289,P<0.05)(OR=1.13,95%CI:0.090-0.160,P<0.05)and EPVS(OR=1.05,95%CI:0.021-0.076,P<0.05)(OR=1.02,95%CI:0.006-0.026,P<0.05).There was no significant different in the serum YKL-40 and MMP-9 levels between lacunar group and non-lacunar group(P>0.05).The serum YKL-40 and MMP-9 levels in the group with CMBs were significantly higher than those in the group without CMBs(P<0.05).The ROC curve showed that the optimal cutoff point of YKL-40 was 0.38,the area under the curve was 0.669(95%CI:0.569-0.768,P<0.01),the optimal cutoff point of MMP-9 was 0.40,and the area under the curve was 0.746(95%CI:0.6

关 键 词：磁共振成像 基质金属蛋白酶9 几丁质酶3样蛋白1 脑小血管病 

分 类 号：R743[医药卫生—神经病学与精神病学]