急性缺血性脑卒中患者血尿酸和基质金属蛋白酶-9与出血转化和临床预后的关系研究

Correlation of serum uric acid and matrix metalloproteinase-9 levels with hemorrhagic transformation and prognosis in patients with acute ischemic stroke

目的探讨急性缺血性脑卒中(AIS)患者血尿酸(UA)和基质金属蛋白酶-9(MMP-9)水平与出血转化和90 d临床预后的相关性。方法选取2021年6月至2022年3月在金华市中心医院首次确诊的AIS患者150例为研究对象。根据头颅CT或MRI表现诊断出血转化21例(出血转化组),未出血转化129例(未出血转化组);随访90 d根据改良Rankin量表评分(mRS)分为预后良好组125例(mRS<3分)和预后不良组25例(mRS≥3分)。采用ELISA法检测所有患者入院当天、第2天、第7天、第14天和第28天UA和MMP-9水平。采用多因素logistic回归分析影响患者出血转化与临床预后的因素,采用ROC曲线评估UA和MMP-9预测出血转化与临床预后的效能。结果150例患者入院当天UA水平最高,MMP-9水平最低;随后UA逐渐降低,MMP-9逐渐升高,至第14天UA水平最低,MMP-9水平最高;随后UA逐渐升高,MMP-9逐渐降低,至第28天UA水平仍低于入院当天,MMP-9水平仍高于入院当天。多因素logistic回归分析显示高龄、大面积脑梗死、溶栓治疗、入院当天MMP-9水平和最大MMP-9差异值(⊿MMP-9)升高、入院当天UA水平和最大UA差异值(⊿UA)降低是出血转化的独立危险因素(均P<0.05)。同样,多因素logistic回归分析显示,大面积脑梗死、入院当天MMP-9水平和⊿MMP-9升高、入院当天UA水平和⊿UA降低是预后不良的独立危险因素(均P<0.01)。ROC曲线显示,入院当天MMP-9水平和⊿MMP-9、UA水平和⊿UA预测出血转化的AUC分别为0.789和0.855,0.842和0.901;入院当天MMP-9水平和⊿MMP-9、UA水平和⊿UA预测预后不良的AUC分别为0.731和0.814,0.798和0.863。结论早期动态监测AIS患者UA和MMP-9水平变化对评估出血转化和90 d临床预后有重要的应用价值,入院当天UA和MMP-9水平及⊿UA和⊿MMP-9预测出血转化和预后不良有较高的效能。

Objective To investigate the correlation of serum uric acid(UA)and matrix metalloproteinase-9(MMP-9)levels with hemorrhagic transformation and prognosis in patients with acute ischemic stroke(AIS).Methods A total of 150 patients with AIS admitted in Jinhua Central Hospital from June 2021 to March 2022 were enrolled,among whom 22 cases were treated with thrombolytic therapy.Serum UA and MMP 9 levels were measured at the day of admission,d2,d7,d14 and d28 after admission.The CT or MRI confirmed that hemorrhagic transformation occurred in 21 cases.The modified Rankin scale(mRS)was used for evaluating clinical outcomes of patients 90 d after admission,there were 125 patients with mRS<3 points(good-prognosis group)and 25 patients with mRS≥3 points(poor-prognosis group).Results The UA level was the highest and MMP-9 level was the lowest in 150 patients on the day of admission;subsequently,UA gradually decreased and MMP 9 gradually increased,on d14,UA level was the lowest and MMP 9 level was the highest.Then UA gradually increased and MMP-9 gradually decreased on d28;however,UA level was still lower and MMP-9 level was still higher than those on the day of admission.Multivariate logistic regression analysis showed that elderly age,large cerebral infarction area,thrombolysis,high MMP 9 at admission and increased⊿MMP 9,and low UA at admission and increased⊿UA were independent risk factors to hemorrhagic transformation(all P<0.05);large cerebral infarction area,high MMP-9 at admission and increased⊿MMP-9,and low UA at admission and increased⊿UA were the independent risk factors for poor prognosis(all P<0.05).The receiver operating characteristic curve(ROC)showed that area under the curve(AUC)of MMP 9 at admission and⊿MMP-9 for predicting hemorrhagic transformation were 0.789 and 0.855 respectively,and the AUC of UA at admission and⊿UA were 0.842 and 0.901 respectively.The AUC of MMP-9 at admission and⊿MMP-9 for predicting poor prognosis were 0.731 and 0.814 respectively,and the AUC of UA at admission and⊿UA were 0.798 and 0.863 respectively.Conclusion The dynamic monitoring of serum UA and MMP 9 levels may be used for evaluating risk of hemorrhagic transformation and for predicting 90 d prognosis in patients with AIS.