血浆基质金属蛋白酶9与急性高血压性脑出血患者血肿扩大的相关性研究

Correlation study of plasma matrix metalloproteinase 9 and hematoma enlargement in patients with acute hypertensive cerebral hemorrhage

目的研究血浆基质金属蛋白酶9(MMP-9)与急性高血压性脑出血血肿扩大的关系。方法前瞻性纳入发病后12 h内经头部CT确诊的高血压性脑出血患者,证实脑出血后4 h内抽取静脉血,检测血浆MMP-9浓度。记录患者入院时血压、头部CT特征、美国国立研究院卒中量表(NIHSS)评分、既往病史等资料。距首次头部CT检查42～54 h内复查CT或患者意识障碍加重时即刻复查CT,与首次CT结果比较,血肿体积差≥12.5 cm3或2次血肿体积之比>1.4即为血肿扩大。分析MMP-9水平与血肿扩大的关系。结果共纳入186例患者,其中41例发生血肿扩大,发生率为22.0%。①单因素分析显示,血肿扩大组MMP-9中位数水平为112μg/L,血肿非扩大组为79μg/L;血肿扩大组入院时的NIHSS评分、首次测量的收缩压水平高于血肿非扩大组,发病至首次CT检查时间短于血肿非扩大组;血肿形态为不规则的比率高于血肿非扩大组。两组上述指标比较,差异有统计学意义。②多因素Logistic回归分析显示,除发病至首次CT检查时间短、血肿形态不规则外,血浆中MMP-9水平升高也是脑出血患者血肿扩大的独立危险因素(OR值=15.65,95%CI:5.30～46.15)。③通过ROC曲线获得MMP-9的临界值为97.5μg/L,其预测血肿扩大的敏感度是0.791,特异度是0.727。结论血浆MMP-9水平增高是急性高血压性脑出血患者血肿扩大的独立危险因素。

Objective To investigate the relationship between plasma matrix metalloproteinase 9 （MMP-9） and hematoma enlargement in patients with acute hypertensive cerebral hemorrhage. Methods The patients with hypertensive cerebral hemorrhage within 12 hours from onset diagnosed with head CT were collected prospectively. Venous blood MMP-9 concentration was detected within 4 hours after cerebral hemorrhage. The data of blood pressure, head CT features, the National Institutes of Stroke Scale （NIHSS） score, past medical history of the patients were documented on admission. The repeated CT scan at 42 to 54 hours from the first one or immediately after disturbance of consciousness of the patients aggravated was taken. Compared to the first CT findings, if the hematoma volume difference ≥ 12.5 cm3 or the hematoma volume difference 〉 1. 4 was considered hematoma enlargement. The relationship between MMP- 9 levels and hematoma enlargement was analyzed. Results A total of 186 patients were enrolled in the study, 41 （22%） of them had hematoma enlargement. ①Univariate analysis showed that the median levels of MMP-9 in the hematoma enlargement group and the non-hematoma enlargement group were 112 μg/L and 79 μg/L respectively; the NIHSS score and the initial systolic blood oressure level in the hematoma enlargement group on admission were higher than those in the non-hematoma enlargement group, and the time from the onset to the first CT scan was shorter than that in the non-hematoma enlargement group. The ratio of irregular hematoma morphology was higher than that in the nou-hematoma enlargement group. There were significant differences between the two groups. ②Multiple logistic regression analysis showed that in addition to the short time from the onset to the first CT scan and irregular hematoma morphology, the increased MMP-9 level was an independent risk factor for hematoma enlargement in patients with intracerebral hemorrhage （ OR = 15.65, 95% CI 5.30 to 46.15）. ③The critical value of MMP-9 obtained through ROC curve was 97.5 μg/L. The sensitivity and specificity of its predicting hematoma enlargement were 0. 791 and 0. 727 respectively. Conclusion The increased plasma MMP-9 level is an independent risk factor for he- matoma enlargement in the patients with hypertensive cerebral hemorrhage.