急性脑梗死患者血清MMP-9、PPARγ水平与非溶栓治疗后出血性转化的相关性

Correlation between serum MMP-9,PPARγlevels and hemorrhagic transformation after non-thrombolytic therapy in patients with acute cerebral infarction

目的探讨急性脑梗死(ACI)患者血清基质金属蛋白酶(MMP)-9、过氧化物酶体增殖物激活受体γ(PPARγ)水平与非溶栓治疗后出血性转化(HT)的关系。方法前瞻性筛选2020年7月至2023年6月中国人民解放军联勤保障部队第九二〇医院收治的ACI患者193例,根据影像学表现是否发生HT可将患者分为HT组(n=39)和非HT组(n=154)。比较两组血清MMP-9、PPARγ水平及一般资料,采用Logistic回归模型分析影响ACI患者非溶栓治疗后发生HT的危险因素,并绘制受试者工作特征(ROC)曲线分析血清PPARγ、MMP-9对ACI患者非溶栓治疗后发生HT的预测价值。结果与非HT组相比,HT组血清PPARγ水平较低,MMP-9水平较高,差异具有统计学意义(P<0.05)。HT组入院美国国立卫生研究院卒中量表(NIHSS)评分、糖尿病占比、房颤病史占比、发病至治疗时间及糖化血红蛋白(HbA1c)、低密度脂蛋白胆固醇(LDLC)、超敏C-反应蛋白(hs-CPR)水平高于非HT组,差异具有统计学意义(P<0.05)。多因素Logistic回归模型显示,有房颤史、hs-CRP和MMP-9水平偏高是导致ACI患者非溶栓治疗后发生HT的独立危险因素,而高水平PPARγ则是发生HT的保护因素(P<0.05)。ROC曲线显示,血清PPARγ、MMP-9单独预测ACI非溶栓治疗后HT的AUC为0.787、0.737,采用log(P)法将PPARγ、MMP-9进行联合,其联合预测的AUC(95%CI)为0.898(0.846~0.937)较单独预测的效能更好(P<0.05)。结论MMP-9高水平是ACI患者非溶栓后发生HT的独立危险因素,PPARγ高水平则是其发生的保护因素,两者联合预测ACI患者非溶栓后发生HT的临床价值较高。

Objective To investigate the relationship between serum matrix metalloproteinase(MMP)-9,peroxisome proliferator-activated receptorγ(PPARγ)levels and hemorrhagic transformation(HT)after non-thrombolytic therapy in patients with acute cerebral infarction(ACI).Methods 193patients with ACI admitted to Neurology Department of the 920th Hospital of the Joint Logistics Support Force of the People’s Liberation Army of China hospital from July 2020to June 2023were prospectively screened.According to the imaging findings,the patients could be divided into HT group(n=39)and non-HT group(n=154).Serum MMP-9and PPAR-9levels and general data of the two groups were compared.Logistic regression model was used to analyze the risk factors affecting the occurrence of HT in ACI patients after non-thrombolytic therapy,and receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum PPAR-9and MMP-9in the occurrence of HT in ACI patients after non-thrombolytic therapy.Results Compared with non-HT group,serum PPARγlevel in HT group was lower and MMP-9level was higher,and the difference was statistically significant(P<0.05).The National Institutes of Health Stroke Scale(NIHSS)score,the proportion of diabetes mellitus,the history of atrial fibrillation,the time from onset to treatment and the levels of HbA1c,low density lipoprotein cholesterol(LDLC)and hypersensitive C-reactive protein(hs-CPR)in the HT group were higher than those in the non-HT group.The difference was statistically significant(P<0.05).Multivariate Logistic regression model showed that history of atrial fibrillation,high levels of hs-CRP and MMP-9were independent risk factors for HT after non-thrombolytic therapy in ACI patients,while high levels of PPARγwere protective factors for HT(P<0.05).ROC curve showed that serum PPARγand MMP-9independently predicted the AUC of HT after ACI non-thrombolytic therapy was 0.787and 0.737.log(P)method was used to combine PPARγand MMP-9.The AUC(95%CI)of the combined prediction was 0.898(0.846~0.937),and the efficiency of the combined prediction was better than that of the single prediction(P<0.05).Conclusion The high level of MMP-9is an independent risk factor for HT after non-thrombolytic treatment in ACI patients,and the high level of PPARγis a protective factor for HT after non-thrombolytic treatment in ACI patients.The combined prediction of HT after non-thrombolytic treatment in ACI patients is of high clinical value.