血清TSP-1联合MMP-9对高血压脑出血患者血肿清除术后发生迟发性脑水肿的预测价值

Predictive value of serum TSP-1 combined with MMP-9 in delayed cerebral edema after hematoma evacuation surgery in patients with hypertensive cerebral hemorrhage

目的探讨血清血小板反应蛋白(TSP)-1联合基质金属蛋白酶(MMP)-9对高血压脑出血(HCH)患者血肿清除术后发生迟发性脑水肿的预测价值。方法选取2020年1月至2023年6月北京市怀柔区中医医院和首都医科大学附属北京中医医院收治的126例HCH患者作为研究对象。所有患者均接受血肿清除手术治疗。观察所有患者术后迟发性脑水肿的发生情况,根据是否发生迟发性脑水肿分为发生组和未发生组。比较两组临床资料,采用多因素Logistic回归分析HCH患者血肿清除术后发生迟发性脑水肿的危险因素。绘制受试者工作特征(ROC)曲线评估血清TSP-1、MMP-9对HCH患者血肿清除术后发生迟发性脑水肿的预测价值。结果126例HCH患者血肿清除术后有35例患者发生迟发性脑水肿,有91例患者未发生迟发性脑水肿。发生组血清TSP-1、MMP-9水平高于未发生组,血肿体积大于未发生组,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,血清TSP-1、MMP-9单独及2项指标联合预测HCH患者血肿清除术后发生迟发性脑水肿的曲线下面积分别为0.761、0.769、0.810。多因素Logistic回归分析结果显示,TSP-1≥75.440 ng/mL、MMP-9≥183.265μg/L、血肿体积≥50.50 mL是HCH患者血肿清除术后发生迟发性脑水肿的危险因素(P<0.05)。结论血清TSP-1、MMP-9联合预测HCH患者血肿清除术后发生迟发性脑水肿的效能较高,二者有望成为预测其发生的有效指标,可为后续临床诊疗提供指导。

Objective To investigate the predictive value of serum thrombocytoreactive protein(TSP)-1 combined with matrix metalloproteinase(MMP)-9 in delayed cerebral edema after hematoma evacuation surgery in patients with hypertensive cerebral hemorrhage(HCH).Methods A total of 126 patients with HCH admitted to Huairou District Traditional Chinese Medicine Hospital of Beijing City and Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University from January 2020 to June 2023 were selected as the study objects.All patients were treated with hematoma evacuation surgery.The occurrence of delayed cerebral edema was observed in all patients,and they were divided into occurrence group and non-occurrence group according to whether delayed cerebral edema occurred.The clinical data of the two groups were compared,and multivariate Logistic regression was used to analyze the risk factors of delayed cerebral edema after hematoma evacuation surgery in patients with HCH.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of serum TSP-1 and MMP-9 in delayed cerebral edema after hematoma evacuation surgery in patients with HCH.Results A total of the 126 patients with HCH after hematoma evacuation surgery,35 patients developed delayed cerebral edema,and 91 patients did not develop delayed cerebral edema.The levels of serum TSP-1 and MMP-9 in the occurrence group were higher than those in the non-occurrence group,and the volume of hematoma in the occurrence group was larger than that in the non-occurrence group,and the differences were statistically significant(P<0.05).ROC curve analysis results showed that the area under the curves of serum TSP-1 and MMP-9 alone and combined with the two indexes in predicting delayed cerebral edema after hematoma evacuation surgery in HCH patients were 0.761,0.769 and 0.810,respectively.Multivariate Logistic regression analysis results showed that TSP-1≥75.440 ng/mL,MMP-9≥183.265μg/L and hematoma volume≥50.50 mL were risk factors for delayed cerebral edema after hematoma evacuation surgery in patients with HCH(P<0.05).Conclusion The combination of serum TSP-1 and MMP-9 is effective in predicting the occurrence of delayed cerebral edema after hematoma evacuation surgery in patients with HCH,which is expected to be an effective means to predict its occurrence and provide guidance for subsequent clinical diagnosis and treatment.