谢勇,李强,吴兴龙,温远平
XIE Yong,LI Qiang,WU Xinglong,WEN Yuanping

• 1:泸州市中医医院神经外科

摘要(Abstract)：

目的 探讨老年高血压脑出血（HICH）患者急诊入院时基质金属蛋白酶（MMPs）水平与患者病情及预后的关系。方法 选取107例急患者急诊入院时老年HICH手术患者作为HICH组、同期体检的100例老年健康体检者作为对照组，分别于入院或体检时抽取外周血，检测血清MMP-2和MMP-9水平；CT检查确定HICH患者脑血肿、脑水肿峰值，采用Pearson分析MMP-2、MMP-9水平与脑血肿、脑水肿峰值的相关性；术后6月用拉斯哥预后（GOS）评分将HICH患者分为预后不良组和预后良好组，记录两组患者发病至手术时间、出血部位及出血量、围术期颅内压等一般资料及入院时血清MMP-2和MMP-9水平，对影响患者预后的指标进行单因素分析、对有差异的指标采用logistics回归分析，用受试者工作特征（ROC）曲线下面积（AUC）评估入院时血清MMP-2、MMP-9水平对老年HICH手术后患者的预测价值。结果 入院时HICH组血清MMP-2、MMP-9水平高于对照组，差异有统计学意义（P<0.001）;HICH患者血清MMP-2、MMP-9水平与脑血肿量、水肿量呈正相关（r=0.602,P=0.037;r=0.615,P=0.031;r=0.634,P=0.023;r=0.596,P=0.041）；高血压病程≥10年、脑出血量≥30 mL、术后第7天的血压较高、术后第7天的颅内压较高、入院时血清MMP-2及MMP-9水平较高分别是HICH患者预后不良的独立危险因素（P<0.05）;ROC曲线显示，入院时MMP-2、MMP-9水平预测HICH患者预后不良的最佳截断值为68.58 mg/L、197.90 mg/L,AUC为0.81、0.777，对应的灵敏度及特异度分别为73.08%、77.78%及72.22%、77.50%。结论 入院时血清MMP-2、MMP-9水平过高是急诊老年HICH患者预后不良的危险因素，其水平对其治疗结局具有一定的预测价值。
Objective To investigate the relationship between MMPs levels and prognosis of patients with senile hypertensive intracerebral hemorrhage(HICH) in acute stage.Methods A total of 107 elderly patients with HICH were selected( HICH group) and 100 healthy elderly volunteers who received synchronous physical examination in our hospital were selected(the control group), and the differences of MMP-2 and MMP-9 levels in acute stage were compared. The peak values of cerebral hematoma and edema in elderly patients with HICH were detected, and the correlation between the levels of MMP-2 and MMP-9 and the peak values of cerebral hematoma and edema in acute stage, as well as the risk factors for poor postoperative prognosis were analyzed. Receiver operating characteristic(ROC) was used to analyze the predictive value of MMP-2 and MMP-9 levels in acute stage for poor surgical prognosis in elderly patients with HICH.Results The levels of serum MMP-2 and MMP-9 in HICH group were higher than those in the control group(P< 0. 05). The levels of MMP-2 and MMP-9 in acute stage of HICH patients were positively correlated with the amount of cerebral hematoma and edema respectively(r= 0. 602,P= 0. 037;r= 0. 615,P= 0. 031;r= 0. 634,P= 0. 023;r= 0. 596,P= 0. 041). Duration of hypertension ≥10 years, cerebral hemorrhage ≥30 mL, high intracranial pressure 7 days after operation, higher intracranial pressure 7 d after surgery, higher levels of MMP-2 and MMP-9 in acute stage were independent risk factors for poor prognosis in HICH patients(P<0. 05). ROC curve showed that best cutoff value of MMP-2 level in acute stage to predict poor prognosis in HICH patients was 68. 58 mg/L.AUCwas 0. 81, and corresponding sensitivity and specificity were 73. 08% and 72. 22% respectively. Optimal cutoff value of MMP-9 level in acute stage for predicting poor prognosis in HICH patients was 197. 90 mg/L.AUCwas 0. 777, and corresponding sensitivity and specificity were 77. 78% and 77. 50% respectively.Conclusion Serum MMP-2 and MMP-9 levels in elderly HICH patients in acute stage are positively correlated with the severity of cerebral hemorrhage and edema. High levels of MMPs are risk factors for poor prognosis, which may play a positive role in disease assessment and prognostic risk screening.

关键词(KeyWords)： 高血压脑出血;急性期;MMP-2;MMP-9;病情;预后;危险因素
hypertensive intracerebral hemorrhage(HICH);acute stage;MMP-2;MMP-9;illness condition;prognosis;risk factors

Abstract:

Keywords:

基金项目(Foundation): 泸州市卫生和计划生育委员会科研课题（2017LH024）

作者(Author): 谢勇,李强,吴兴龙,温远平
XIE Yong,LI Qiang,WU Xinglong,WEN Yuanping

DOI: 10.19367/j.cnki.2096-8388.2022.04.014

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