脑梗死血清MMP-9、Lp-PLA2、Hcy水平与早期神经功能恶化的关系研究

Relationship between Serum MMP-9,Lp-PLA2 and Hcy Levels and Early Neurological Deterioration in Patients with Cerebral Infarction

目的探究脑梗死患者血清基质金属蛋白酶-9(MMP-9)、脂蛋白相关磷脂酶A2(Lp-PLA2)、同型半胱氨酸(Hcy)水平与早期神经功能恶化(END)的联系。方法纳入2020年4月至2023年4月于本院收治的脑梗死患者112例,根据是否发生END分为恶化组、非恶化组,对比两组患者一般资料、MMP-9、Lp-PLA2及Hcy水平的差异,进行多因素Logistic回归分析,评估脑梗死患者END影响因素,绘制ROC曲线,分析血清MMP-9、Lp-PLA2、Hcy水平与END的关系。结果112例脑梗死患者中,有79例未发生END作为非恶化组,占比70.54%;33例发生END的患者作为恶化组,占比29.46%。对比两组性别、年龄、身体质量指数(BMI)、高血压病情、糖尿病病情、高脂症均无明显差异(P>0.05)。恶化组舒张压、发病至治疗时间、入院NIHSS评分、MMP-9、Lp-PLA2、Hcy高于非恶化组,差异有统计学意义(P<0.05)。多因素分析显示MMP-9、Lp-PLA2、Hcy均为脑梗死患者发生END的独立影响因素(P<0.05)。ROC曲线分析,血清MMP-9、Lp-PLA2、Hcy预测AIS患者不良预后的曲线下面积(AUC)分别为0.914、0.867、0.883,敏感度分别为0.909、0.836、0.879,特异度分别是0.797、0.962和0.823。结论MMP-9、Lp-PLA2、Hcy水平与脑梗死患者END密切相关,其可能是通过调节机体炎症反应、血脑屏障损伤进程影响患者的神经功能,可为脑梗死患者END预测提供可靠信息。

Objective To discuss the relationship between serum matrix metalloproteinase-9(MMP-9),lipoprotein-associated phospholipase A2(Lp-PLA2)and homocysteine(Hcy)levels and early neurological deterioration(END)in patients with cerebral infarction.Methods A total of 112 patients with cerebral infarction admitted to the hospital from April 2020 to April 2023 were selected divided into the END group and the non-END group.General information,MMP-9,Lp-PLA2 and Hcy levels of the two groups were compared.Multivariate logistic regression analysis and the receiver operating characteristic(ROC)curve analysis were performed.The relationship between serum MMP-9,Lp-PLA2 and Hcy levels and END was analyzed.Results Among 112 patients with cerebral infarction,there were 79(70.54%)patients without END and 33(29.46%)patients with END.There was no statistically significant difference in gender,age,body mass index(BMI),hypertension,diabetes,or hyperlipidemia between the two groups(P>0.05).Diastolic blood pressure,the time from onset to treatment,the NIHSS score at admission,MMP-9,Lp-PLA2 and Hcy levels in the END group were significantly higher/longer than those in the non-END group(P<0.05).Multivariate logistic regression analysis found that MMP-9,Lp-PLA2 and Hcy were independent influencing factors of END in patients with cerebral infarction(P<0.05).ROC curve analysis showed that the AUC values of serum MMP-9,Lp-PLA2 and Hcy for predicting poor prognosis of patients with cerebral infarction were 0.914,0.867 and 0.883.The sensitivity was 0.909,0.836 and 0.879,respectively.The specificity was 0.797,0.962 and 0.823,respectively.Conclusion The levels of MMP-9,Lp-PLA2 and Hcy are closely related to END in patients with cerebral infarction.They may affect the patient's neurological function by regulating inflammatory response and the process of blood-brain barrier damage,providing reliable information for predicting END in patients with cerebral infarction.