血清sRAGE、Hcy、MMP-9水平与急性脑梗死患者机械取栓后出血性转化发生风险间的相关性分析

Correlation analysis between serum levels of sRAGE,Hcy,MMP-9 and the risk of hemorrhagic transformation after mechanical embolectomy in patients with acute cerebral infarction

目的探讨血清可溶性期糖基化终末产物受体(sRAGE)、同型半胱氨酸(Hcy)、基质金属蛋白酶-9(MMP-9)水平与急性脑梗死(ACI)患者机械取栓后出血性转化(HT)发生风险间的相关性。方法回顾性分析2020年1月至2023年2月北京市海淀医院收治的82例ACI行机械取栓治疗患者的临床资料,患者入院后均接受机械取栓治疗,治疗结束后3 d依据患者头部CT和MRI检查结果明确其颅内是否发生出血,并分为HT组(n=30)与无HT组(n=52)。比较两组一般资料信息[性别、年龄、体重指数、合并疾病(高血压、高脂血症、糖尿病)、脑卒中史、吸烟史、是否术前静脉溶栓、院前抗血小板或抗凝以及术前美国国立卫生研究院卒中量表(NIHSS)评分、术后收缩压]以及实验室指标(sRAGE、Hcy、MMP-9)水平的差异。通过受试者工作特征(ROC)曲线明确术前NIHSS评分、术后收缩压、sRAGE、Hcy、MMP-9对于预测ACI取栓治疗后发生HT的价值。通过多因素Logistic回归分析明确ACI取栓治疗后发生HT的危险因素。结果治疗结束后3 d评估患者头部CT和MRI检查结果显示,82例患者中HT发生率为36.59%(30/82),无HT发生率为63.41%(52/82),分别设为HT组与无HT组。两组性别构成比、年龄、体重指数、合并高血压、合并高脂血症、合并糖尿病、脑卒中史、吸烟史、术前静脉溶栓、院前抗血小板或抗凝比较,差异均无统计学意义(P>0.05);无HT组术前NIHSS评分、术后收缩压、Hcy、MMP-9水平均显著低于HT组,血清sRAGE显著高于HT组,差异均有统计学意义(P<0.05)。经ROC曲线分析证实术前NIHSS评分、术后收缩压水平、sRAGE、Hcy、MMP-9均可用于ACI取栓治疗后发生HT的预测,曲线下面积分别为0.696、0.862、0.791、0.924、0.812,预测价值较好(P<0.05)。经多因素Logistic回归分析证实,术前NIHSS评分≥11.505分、术后收缩压水平≥140.435 mmHg、sRAGE≤1.215 ng/mL、Hcy≥16.540μmol/L、MMP-9≥145.390μg/L是ACI患者取栓治疗后发生HT的危险因素(P<0.05)。结论ACI取栓治疗后发生HT受到较多因素的影响,当术前NIHSS评分≥11.505分、术后收缩压水平≥140.435 mmHg、sRAGE≤1.215 ng/mL、Hcy≥16.540μmol/L、MMP-9≥145.390μg/L时可用于此类患者HT风险的预测。

Objective To explore the correlation between the levels of soluble glycation end product receptor(sRAGE),homocysteine(Hcy),matrix metalloproteinase-9(MMP-9)and the risk of hemorrhagic transformation(HT)in patients with acute cerebral infarction(ACI)after mechanical thrombectomy.Methods The clinical data of 82 patients with ACI who were treated with mechanical embolectomy from January 2020 to February 2023 were retrospectively analyzed.All patients received mechanical embolectomy after admission.Three days after treatment,the intracranial hemorrhage was determined according to the results of CT and MRI examination of the patient's head,and patients were divided into HT group(n=30)and non-HT group(n=52).The differences in general information[gender,age,body mass index,comorbid diseases(hypertension,hyperlipidemia,diabetes),stroke history,smoking history,whether preoperative intravenous thrombolysis,pre hospital antiplatelet or anticoagulation,preoperative NIHSS score,postoperative systolic blood pressure level]and serum levels of laboratory indicators(sRAGE,Hcy,MMP-9)between the two groups were compared.The value of preoperative NIHSS score,postoperative systolic blood pressure level,sRAGE,Hcy and MMP-9 in predicting the occurrence of HT after ACI thrombectomy was determined by receiver operating characteristic(ROC)curve.The risk factors of HT after ACI thrombectomy were determined by multivariate Logistic regression analysis.Results The results of CT and MRI examination of the head evaluated 3 days after the treatment showed that the incidence of HT in 82 patients was 36.59%(30/82),and the incidence of non-HT was 63.41%(52/82).They were divided into HT group and non-HT group respectively.There was no statistically significant difference in sex,age,body mass index,hypertension,hyperlipidemia,diabetes,stroke,smoking,preoperative intravenous thrombolysis,pre hospital antiplatelet or anticoagulation between the two groups(P>0.05);the preoperative NIHSS score,postoperative systolic blood pressure,Hcy and MMP-9 levels in the non-HT group were significantly lower than those in the HT group,and the serum sRAGE was significantly higher than that in the HT group,the differences were statistically significant(P<0.05).The ROC curve analysis confirmed that preoperative NIHSS score,postoperative systolic blood pressure level,sRAGE,Hcy and MMP-9 could be used to predict the occurrence of HT after ACI thrombectomy,and the area under the curve was 0.696,0.862,0.791,0.924 and 0.812,respectively,had good predictive value(P<0.05).Multivariate Logistic regression analysis confirmed that preoperative NIHSS score≥11.505,postoperative systolic blood pressure level≥140.435 mmHg,sRAGE≤1.215 ng/mL,Hcy≥16.540μmol/L,MMP-9≥145.390μg/L were risk factors for HT in patients with ACI after thrombectomy(P<0.05).Conclusion The occurrence of HT after ACI thrombectomy is affected by many factors.When the preoperative NIHSS score≥11.505,the postoperative systolic blood pressure level≥140.435 mmHg,sRAGE≤1.215 ng/mL,Hcy≥16.540μmol/L,MMP-9≥145.390μg/L,it can be used to predict the risk of HT in such patients.