血尿酸、MMP-2、MMP-9水平对急性缺血性脑卒中患者静脉溶栓后脑出血转化的预测价值

Predictive value of serum uric acid,MMP-2 and MMP-9 levels for cerebral hemorrhage transformation in pa⁃tients with acute ischemic stroke after intravenous thrombolysis

目的分析血尿酸、血浆基质金属蛋白酶(MMP)-2、MMP-9水平对急性缺血性脑卒中(AIS)患者静脉溶栓后脑出血转化的预测价值。方法选取186例AIS患者,均行静脉溶栓治疗,根据脑出血情况分为出血转化组49例与未出血转化组137例,比较两组以及不同预后结局AIS患者溶栓治疗后的血尿酸、MMP-2、MMP-9水平,利用ROC曲线分析血尿酸、MMP-2、MMP-9水平对AIS患者静脉溶栓后脑出血转化以及预后的预测价值。结果出血转化组患者静脉溶栓后的血尿酸水平低于未出血转化组,溶栓治疗前神经功能缺损评分(NIHSS)评分、发病至溶栓治疗时间以及MMP-2、MMP-9水平高于未出血转化组,高血压、房颤既往病史、吸烟史占比高于未出血转化组,差异均有统计学意义(t分别=10.39、5.36、3.90、11.26、6.20,χ^(2)分别=7.14、10.26、5.42,P均<0.05)。预后不佳组静脉溶栓后的血尿酸水平低于预后良好组,MMP-2、MMP-9水平高于预后良好组,差异均有统计学意义(t分别=5.42、19.57、13.04,P均<0.05)。血尿酸、MMP-2、MMP-9预测AIS患者静脉溶栓后脑出血转化的AUC分别为0.78、0.80和0.83,临界值分别为317.63 mmol/L、3.84 ng/L和391.14 mg/L;MMP-9的灵敏度和特异度最高,分别为70.40%、91.67%;血尿酸、MMP-2、MMP-9预测AIS患者预后的AUC分别为0.73、0.79和0.82,临界值分别为388.89 mmol/L、3.93 ng/L和400.12 mg/L;MMP-9的灵敏度和特异度最高,分别为67.50%、90.45%。结论血尿酸、MMP-2、MMP-9不但能有效预测AIS患者静脉溶栓后脑出血,还能较好预测患者预后。

Objective To analyze the predictive value of serum uric acid,plasma matrix met alloproteinase(MMP)-2 and MMP-9 levels for cerebral hemorrhage transformation in patients with acute ischemic stroke(AIS)after intravenous thrombolysis.Methods A total of 186 patients with AIS were enrolled and underwent intravenous thrombolysis.Accord-ing to cerebral hemorrhage status,they were divided into transformation group(49 cases)and non-transformation group(137 cases).The levels of serum uric acid,MMP-2 and MMP-9 between the two groups and among AIS patients with different prognosis were compared.The predictive value of serum uric acid,MMP-2 and MMP-9 levels for cerebral hemor-rhage transformation and prognosis of AIS patients after intravenous thrombolysis were analyzed by ROC curves.Results The level of serum uric acid after intravenous thrombolysis in transformation group was lower than that in non-transforma-tion group,NIHSS score before thrombolysis,interval from onset to thrombolysis,MMP-2 and MMP-9 levels were higher than those in non-transformation group,and proportions of cases with hypertension,atrial fibrillation and smoking histories were higher than those in non-transformation group(t=10.39,5.36,3.90,11.26,6.20.χ^(2)=7.14,10.26,5.42.P<0.05).After intravenous thrombolysis,the level of serum uric acid in poor prognosis group was lower than that in good prognosis group,while levels of MMP-2 and MMP-9 were higher than those in good prognosis group(t=5.42,19.57,13.04.P<0.05).AUC and cut-off values of serum uric acid,MMP-2 and MMP-9 for predicting cerebral hemorrhage transformation were(0.78,0.80,0.83)and(317.63 mmol/L,3.84 ng/L,391.14 mg/L),respectively.The sensitivity and specificity of MMP-9 were the highest(70.40%,91.67%).AUC and cut-off values of serum uric acid,MMP-2 and MMP-9 for predict-ing prognosis of AIS patients were(0.73,0.79,0.82)and(388.89 mmol/L,3.93 ng/L,400.12 mg/L),respectively.The sensitivity and specificity of MMP-9 were the highest(67.50%,90.45%).Conclusion The serum uric acid,MMP-2 and MMP-9 can not only effectively predict cerebral hemorrhage in AIS patients after intravenous thrombol-ysis,but also can better predict prognosis.