MMP-9、GFAP和FN浓度与脑梗死后出血转化的预测作用

Prediction of MMP-9, GFAP and FN concentration for hemorrhagic transformation after cerebral infarction

目的探讨基质金属蛋白酶-9(MMP-9)、胶质纤维酸性蛋白(GFAP)和纤维连接蛋白(FN)对脑梗死后出血转化的预测价值。方法选取该院64例首发急性脑梗死患者为病例组,选取同期64例在体检中心体检的受试者为对照组。对比两组受试者的MMP-9、GFAP和FN浓度。根据入院后1周的颅脑MRI检查结果,将病例组分为出血转化组9例和非出血转化组55例,对比两组患者的各项临床资料,并通过多因素分析得出脑梗死后出血转化的独立预测因素。分析MMP-9、GFAP和FN的检测对脑梗死后出血转化的预测价值。结果病例组的MMP-9浓度、GFAP浓度、FN浓度均显著高于对照组(均P<0.05)。出血转化组合并心房纤颤的比例为44.44%,入院收缩压为(181.94±19.63)mmHg,入院舒张压为(97.74±10.31)mmHg,MMP-9浓度为(1 369.91±358.31)μg/L,GFAP浓度为(3 598.82±632.71)ng/L,FN浓度为(4 828.91±749.28)μg/L,均显著高于非出血转化组(均P<0.05)。多因素分析显示,心房纤颤、MMP-9浓度、GFAP浓度、FN浓度是脑梗死后出血转化的独立预测因素;MMP-9、GFAP、FN三个指标联合检测的敏感性为77.78%,特异性为70.91%,阳性预测值为30.43%,阴性预测值为95.12%,准确度为71.88%。结论心房纤颤,MMP-9、GFAP和FN水平是脑梗死后出血转化发生的独立预测因素,MMP-9、GFAP、FN的联合检测预测脑梗死后出血转化的发生价值优于单独检测或者两两联合检测。

[Objective] To investigate the prediction of matrix metalloproteinase-9 （MMP-9）, glial fibrillary acidic protein （GFAP） and fibronectin （FN） for hemorrhagic transformation after cerebral infarction. [ Methods] Sixty-four patients with acute cerebral infarction in our hospital were involved and 64 cases from health examination center at the same period were involved as the control subjects. MMP-9, GFAP and FN concentrations of the two groups were detected and compared. According to the head MRI scan results one-week after admission, the case subjects were divided into hemorrhagic transformation （HT） group with 9 cases and non hemorrhagic transformation （NHT） group with 55 cases. The clinical data of the two groups were compared： The independent predictors of hemorrhagic transformation after cerebral infarction were obtained by multiple factor analysis. The prediction of MMP-9, GFAP and FN for hemorrhagic transformation after cerebral infarction was analyzed. [Results] The MMP-9 concentration, GFAP concentration and FN concentration were significantly higher than the control subjects （all P 〈0.05）. In HT group, the rate of combining with atrial fibrillation was 44.44%. The systolic blood pressure in admission was （181.94±19.63） mmHg and diastolic blood pressure was （97.74±10.31） mmHg. The concentration of MMP-9, GFAP and FN was（1 369.91± 358.31） μg/L, （3 598.82 ± 632.71） ng/L and （4 828.91 ± 749.28）μg/L. The above date were significantly higher than those of NHT group（all P 〈0.05）. Multivariate analysis showed that atrial fibrillation, MMP- 9, GFAP and FN were independent predietors for hemorrhagic transformation after cerebral infarction. The sensitivity of MMP-9, GFAP and FN combined deteetion indexes was 77.78%. The specificity was 70.91% and the positive predictive value was 30.43%. The negative predictive value was 95.12% and the aeeuraey was 71.88%. [ Conclusions ] Atrial fibrillation, MMP-9, GFAP and FN eoncentration were independent predictors for hemorrhagic transformation after cerebral infarction. The value of combined detection of MMP-9, GFAP and FN is better than the single or combined detection to predict the occurrence of hemorrhagic transformation after cerebral infarction.