基质金属蛋白酶9、脂蛋白相关磷脂酶A2与急性缺血性卒中静脉溶栓预后及脑出血转化的相关性

余小艳; 丛光燕; 吕鸿燕; 张勇; 朱杰

doi:10.13898/j.cnki.issn.1000-2200.2023.06.014

基质金属蛋白酶9、脂蛋白相关磷脂酶A2与急性缺血性卒中静脉溶栓预后及脑出血转化的相关性

Correlation of matrix metalloproteinase-9 and lipoprotein associated phospholipase A2 with prognosis and hemorrhagic transformation in acute ischemic stroke patients with intravenous thrombolysis

摘要

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。

Abstract:
ObjectiveTo 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.
MethodsA 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.
ResultsThe 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%.
ConclusionsThe 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.

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