摘要
目的:探讨溶栓治疗的急性缺血性脑卒中病人入院时基质金属蛋白酶9(MMP-9)和脂蛋白相关磷脂酶A2(Lp-PLA2)表达与短期预后及脑出血转化的相关性。方法:选取进行rt-PA静脉溶栓治疗的65例急性缺血性卒中病人,记录其人口统计学特征、病情严重程度、入院时MMP-9和Lp-PLA2水平及脑出血转化情况,采用多因素logistic评价MMP-9和Lp-PLA2及其他基线资料与短期预后及脑出血转化的相关性,应用ROC曲线分析MMP-9和Lp-PLA2对预后的预测价值。结果:预后不良组血清MMP-9、Lp-PLA2水平明显高于预后良好组(P<0.01)。对预后不良最有意义的危险因素为MMP-9、Lp-PLA2及溶栓前NIHSS评分(P<0.05~P<0.01)。年龄、溶栓前NIHSS评分、MMP-9和Lp-PLA2水平是发生溶栓后出血转化的高危因素(P<0.01)。对于出血转化最有意义的危险因素为年龄、MMP-9、Lp-PLA2及溶栓前NIHSS评分(P<0.05~P<0.01)。ROC曲线分析显示,MMP-9预测预后不良的曲线下的面积为0.773(95%CI:0.649~0.898),截断值163.65 ng/mL,敏感度88.6%,特异度73.3%;Lp-PLA2的ROC曲线下的面积为0.705(95%CI:0.574~0.836),截断值244.20 ng/mL,敏感度82.9%,特异度83.3%。结论:MMP-9、Lp-PLA2水平是急性缺血性卒中rt-PA静脉溶栓短期预后的独立影响因素,且与脑出血转化有关。
Objective:To evaluate the correlation of matrix metalloproteinase-9(MMP-9)and lipoprotein associated phospholipase A2(Lp-PLA2)levels on admission with short-term prognosis and hemorrhagic transformation(HT)in patients with acute ischemic stroke treated with thrombolysis.Methods:A total of 65 acute ischemic stroke patients treated with rt-PA intravenous thrombolysis were selected.Demographics,disease severity,the MMP-9 and Lp-PLA2 levels on admission and HT were prospectively recorded.Multivariate logistic analysis was used to evaluate the correlation between MMP-9,Lp-PLA2 and other baseline data with short-term prognosis and HT.ROC curve analysis was used to analyze the predictive value of MMP-9 and Lp-PLA2 levels for prognosis.Results:The levels of serum MMP-9 and Lp-PLA2 in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.01).The most significant risk factors for poor prognosis were MMP-9,Lp-PLA2 and NIHSS score before thrombolysis(P<0.05 to P<0.01).The age,NIHSS score before thrombolysis,MMP-9 and Lp-PLA2 levels were the high risk factors for HT after thrombolysis(P<0.01).The most significant risk factors for HT were age,MMP-9,Lp-PLA2 and NIHSS score before thrombolysis(P<0.05 to P<0.01).The ROC curve analysis showed that the area under the curve of MMP-9 predicting poor prognosis was 0.773(95%CI:0.649-0.898),the cutoff value was 163.65 ng/mL,the sensitivity was 88.6%,and the specificity was 73.3%.The area under the ROC curve of Lp-PLA2 was 0.705(95%CI:0.574-0.836),the cutoff value was 244.20 ng/mL,the sensitivity was 82.9%,and the specificity was 83.3%.Conclusions:The levels of MMP-9 and Lp-PLA2 are independent predictors for short-term prognosis after rt-PA intravenous thrombolysis in acute ischemic stroke patients,and relate to intracerebral hemorrhage transformation.
作者
余小艳
丛光燕
吕鸿燕
张勇
朱杰
YU Xiao-yan;CONG Guang-yan;L Hong-yan;ZHANG Yong;ZHU Jie(Department of Neurology,The Lu′an Hospital Affiliated to Anhui Medical University,Lu′an Peoples Hospital,Lu′an Anhui 237005,China;Department of Internal Medicine,The Lu′an Hospital Affiliated to Anhui Medical University,Lu′an Peoples Hospital,Lu′an Anhui 237005,China)
出处
《蚌埠医学院学报》
CAS
2023年第6期772-775,共4页
Journal of Bengbu Medical College
基金
安徽医科大学科学研究基金资助项目(2021xkj099)。
关键词
缺血性脑卒中
基质金属蛋白酶9
脂蛋白相关磷脂酶A2
溶栓
出血转化
ischemic stroke
matrix metalloproteinase 9
lipoprotein associated phospholipase A2
thrombolysis
hemorrhagic transformation
