CTA联合血清MMP-9、TIMP-1在缺血性脑卒中诊断中的应用

Application of CTA combined with serum MMP⁃9 and TIMP⁃1 in the diagnosis of ischemic stroke

目的 探究CT血管成像(CTA)联合血清基质金属蛋白酶9(MMP-9)、金属蛋白酶组织抑制因子1(TIMP-1)在缺血性脑卒中诊断中的应用。方法 选取2021年5月至2022年5月期间张家口市第一医院神经内科收治的140例脑卒中患者作为研究组研究对象,均行CTA检查,以数字血管造影(DSA)为金标准,分析CTA对缺血性脑卒中诊断价值,另选择同期至此院进行体检的健康者80名作为对照组,比较两组患者血清MMP-9、TIMP-1水平。结果 140例患者,共检查463条头颈血管,经CTA诊断无狭窄236条、轻度狭窄66条、中度狭窄36条、重度狭窄46条、闭塞22条,与DSA对照CTA诊断缺血性脑卒中患者血管狭窄程度的灵敏度为81.25%,特异度为90.15%;CTA诊断轻度狭窄患者74例、中度16例、重度46、闭塞4例,与DSA对照CTA诊断灵敏度82.50%、特异度83.33%;研究组患者血清MMP-9、TIMP-1表达水平均显著高于对照组患者,差异有统计学意义(t=73.668、33.925,P<0.05),且研究组患者随着狭窄程度增加,血清MMP-9、TIMP-1水平逐渐上升,差异有统计学意义(F=13298.37、901.001,P<0.05);MMP-9以247.14 ng/mL为临界值,阳性53例,阴性87例;TIMP-1均值(239.21 ng/mL)为临界值,阳性53例,阴性87例;以CTA阳性为基础,MMP-9、TIMP-1任一指标阳性则定义为联合诊断阳性,结果显示联合诊断灵敏度为88.75%,特异度为80.00%。结论 CTA联合血清MMP-9、TIMP-1对缺血性脑卒中诊断效能较高,临床应在密切观察缺血性脑卒中患者CTA检查基础上联合MMP-9、TIMP-1水平检测。

Objective To explore the application of CT angiography(CTA)combined with se⁃rum matrix metalloproteinase 9(MMP⁃9)and tissue inhibitor of metalloproteinase 1(TIMP⁃1)in the diagno⁃sis of ischemic stroke.Methods From May 2021 to May 2022,140 patients with cerebral infarction were ad⁃mitted to the Department of Neurology at our hospital.They were selected as the study group and had under⁃gone CTA.Digital subtraction angiography(DSA)was used as the gold standard to analyze the diagnostic val⁃ue of CTA in ischemic stroke.Additionally,80 healthy individuals who visited the hospital for physical examination during the same period were selected as the control group.Serum MMP⁃9 and TIMP⁃1 levels were com⁃pared between the two groups.Results A total of 463 head and neck vessels were examined in the 140 pa⁃tients.CTA diagnosed 236 vessels without stenosis,66 with mild stenosis,36 with moderate stenosis,46 with severe stenosis,and 22 with occlusion.Compared with DSA,the sensitivity and specificity of CTA in diagnos⁃ing vascular stenosis in patients with ischemic stroke were 81.25%and 90.15%.CTA diagnosed 74 cases of mild stenosis,16 cases of moderate stenosis,46 cases of severe stenosis,and 4 cases of occlusion.Compared with DSA,the diagnostic sensitivity and specificity of CTA were 82.50%and 83.33%.In the study group,se⁃rum MMP⁃9 and TIMP⁃1 levels were significantly higher than those in the control group(t=73.668,33.925,P<0.05).As stenosis worsened,serum MMP⁃9 and TIMP⁃1 levels increased(F=13298.37,901.001,P<0.05).MMP⁃9 at 247.14 ng/mL as the critical value,there were 53 positive cases and 87 negative cases.TIMP⁃1 at 239.21 ng/mL as the critical value resulted in 53 positive cases and 87 negative cases.The sensitivity and specificity of the combined diagnosis were 88.75%and 80.00%.Conclusion CTA combined with serum lev⁃els of MMP⁃9 and TIMP⁃1 can enhance the diagnostic accuracy for ischemic stroke.