水肿体积 MMP-9 NSE与基底节脑出血外侧裂入路手术疗效的关系及预后预测价值

doi:10.3969/j.issn.1006-6233.2021.09.009

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摘要 目的: 探究水肿体积、基质金属蛋白酶-9(MMP-9)、神经元特异性烯醇化酶(NSE)与基底节脑出血外侧裂入路手术疗效的关系,并分析各指标预测患者预后价值。方法: 选取2019年5月至2020年8月我院收治的150例基底节脑出血患者,均行外侧裂入路手术治疗,根据手术治疗效果分为有效组和无效组,比较两组临床资料、治疗前后血肿周围相对水肿体积(rPHE)及血清MMP-9、NSE水平,采用Pearson相关系数模型分析rPHE、血清MMP-9、NSE与患者神经功能(NHISS评分)的相关性,采用Logistic回归模型分析手术疗效的影响因素,治疗后随访3个月,统计患者预后情况,比较不同预后患者手术治疗后rPHE及血清MMP-9、NSE水平,采用受试者工作特征(ROC)曲线分析手术治疗后rPHE、血清MMP-9、NSE预测患者预后的价值。结果: 有效组治疗前NIHSS评分、血肿体积、治疗前后血清MMP-9、NSE水平均低于无效组,治疗前后rPHE均高于无效组(P<0.05);基底节脑出血患者治疗前NHISS评分与rPHE呈负相关,与血清MMP-9、NSE水平呈正相关(P<0.05);治疗前NIHSS评分、血肿体积、rPHE及血清MMP-9、NSE水平均为基底节脑出血患者外侧裂入路手术疗效的影响因素(P<0.05);预后良好患者手术治疗后rPHE高于预后不良患者,血清MMP-9、NSE水平低于预后不良患者(P<0.05);手术治疗后rPHE及血清MMP-9、NSE预测患者预后的曲线下面积(AUC)均>0.7,其中血清NSE预测的AUC最大,为0.822,当其取截断值20.38μg/L时,预测敏感度、特异度分别为76.67%、83.33%。结论: rPHE、血清MMP-9、NSE与基底节脑出血外侧裂入路手术的疗效显著相关,且术后早期各指标在预测患者预后方面具有良好应用价值。

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关键词 ：基底节脑出血, 外侧裂入路手术, 水肿体积, 基质金属蛋白酶-9, 神经元特异性烯醇化酶

Abstract：Objective: To explore the relationship between edema volume, matrix metalloproteinase-9 (MMP-9), neuron-specific enolase (NSE) and the curative effect of the lateral fissure approach of basal ganglia intracerebral hemorrhage, and analyze the prognostic value of each index. Methods: 150 patients with basal ganglia cerebral hemorrhage admitted to our hospital from May 2019 to August 2020 were selected for surgical treatment of lateral fissure approach. According to the effect of surgical treatment, they were divided into effective group and ineffective group. The clinical data, relative perihematomal edema (rPHE) and serum MMP-9 and NSE levels before and after treatment were compared between the two groups. The Pearson correlation coefficient model was used to analyze the correlation between rPHE, serum MMP-9, NSE and the patient's neurological function (NHISS score), and the logistic regression model was used to analyze the factors affecting the surgical efficacy. Follow-up for 3 months after treatment, the prognosis of the patients was counted, and the levels of rPHE and serum MMP-9 and NSE in patients with different prognosis were compared after surgical treatment. The receiver operating characteristic (ROC) curve was used to analyze the prognostic value of rPHE, serum MMP-9, and NSE after surgical treatment.Results: The NIHSS score, hematoma volume, serum MMP-9 and NSE levels before and after treatment in the effective group were lower than those in the ineffective group, and rPHE before and after treatment was higher than that in the ineffective group (P<0.05). Before treatment, NHISS score of patients with basal ganglia intracerebral hemorrhage was negatively correlated with rPHE, and positively correlated with serum MMP-9 and NSE levels (P<0.05). Before treatment, NIHSS score, hematoma volume, rPHE, serum MMP-9, and NSE levels were all influencing factors for the curative effect of lateral fissure approach surgery in patients with basal ganglia intracerebral hemorrhage (P<0.05). The rPHE of patients with good prognosis after surgical treatment was higher than that of patients with poor prognosis, and the levels of serum MMP-9 and NSE were lower than those with poor prognosis (P<0.05). After surgical treatment, the area under the curve (AUC) of rPHE, serum MMP-9 and NSE predicting the prognosis of patients were all>0.7. Among them, the AUC predicted by serum NSE was the largest, which was 0.822. When the cut-off value was 20.38 μg/L, the prediction sensitivity and specificity were 76.67% and 83.33%, respectively. Conclusion: RPHE, serum MMP-9, NSE are significantly related to the curative effect of basal ganglia intracerebral hemorrhage with lateral fissure approach, and early postoperative indicators have good application value in predicting the prognosis of patients.

Key words： Basal ganglia intracerebral hemorrhage Lateral fissure approach surgery Edema volume Matrix metalloproteinase-9 Neuron-specific enolase

基金资助:陕西省医学科学研究重点课题计划,(编号:2017Jm²288)

通讯作者: 游文良

引用本文:

王海波, 游文良. 水肿体积 MMP-9 NSE与基底节脑出血外侧裂入路手术疗效的关系及预后预测价值[J]. 河北医学, 2021, 27(9): 1444-1449.
WANG Haibo, YOU Wenliang. The Relationship Between the Volume of Edema MMP-9 NSE and the Surgical Effect of Lateral Fissure Approach of Basal Ganglia Intracerebral Hemorrhage and Its Prognostic Value. HeBei Med, 2021, 27(9): 1444-1449.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.09.009 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I9/1444

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