文章摘要
金祥兵,邓明均,吴晓宏,等.血清缺氧诱导因子 -1α、内皮素 -1及基质金属蛋白酶 -9联合检测对颅内动脉瘤破裂出血 142例手术预后的价值[J].安徽医药,2024,28(6):1186-1191.
血清缺氧诱导因子 -1α、内皮素 -1及基质金属蛋白酶 -9联合检测对颅内动脉瘤破裂出血 142例手术预后的价值
Prognostic value of combined detection of serum HIF-1α, ET-1 and MMP-9 in 142 cases of ruptured intracranial aneurysm hemorrhage after surgery
  
DOI:10.3969/j.issn.10096469.2024.06.028
中文关键词: 颅内动脉瘤  动脉瘤,破裂  缺氧诱导因子 -1α  内皮素 -1  基质金属蛋白酶 -9  预后
英文关键词: Intracranial aneurysm  Aneurysm, ruptured  Hypoxia-inducible factor-1α  Endothelin-1  Matrix metalloproteinase-9  Prognosis
基金项目:
作者单位E-mail
金祥兵 东台市人民医院神经外科江苏东台 224200  
邓明均 东台市人民医院神经外科江苏东台 224200 3500815602@qq.com 
吴晓宏 东台市人民医院神经外科江苏东台 224200  
丁冬官 东台市人民医院神经外科江苏东台 224200  
陈伟 东台市人民医院神经外科江苏东台 224200  
王冰 东台市人民医院神经外科江苏东台 224200  
何强 东台市人民医院神经外科江苏东台 224200  
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中文摘要:
      目的探讨血清缺氧诱导因子 -1α(HIF-1α)、内皮素 -1(ET-1)、基质金属蛋白酶 -9(MMP-9)联合预测颅内动脉瘤破裂出血术后预后不良的价值。方法选取 2020年 1月至 2022年 1月东台市人民医院收治的颅内动脉瘤破裂出血病人 142例作为研究组,另选取同期健康体检者 140例作为对照组,检测病人术前、入院 1周(均为术后)、术后 6个月血清 HIF-1α、ET-1、MMP-9水平并进行比较。另依据病人出院 6个月后预后情况,将其分为预后良好组( 101例)和预后不良组(41例),对比预后良好组和预后不良组术前、入院 1周、术后 6个月血清 HIF-1α、ET-1、MMP-9水平,分析颅内动脉瘤破裂出血病人预后不良的影响因素及血清 HIF-1α、ET-1、MMP-9单项及联合检测对颅内动脉瘤破裂出血病人预后不良的预测价值。结果研究组术前血清 HIF-1α、 ET-1、MMP-9水平均高于对照组(P<0.05);研究组随访 6个月预后不良发生率为 28.87%(41/142)血清 HIF-1α、ET-1、MMP-9水平经重复测量方差分析差异有统计学意义(P<0.05),预后不良组入院 1周、术后 6个月血清 HIF-1α(,42.43±3.05)μg/L和(41.53±4.52)μg/L、ET-1(14.27±1.24)ng/L和( 13.96±2.04)ng/L、MMP-9(15.57±1.81)μg/L和( 14.68±2.65)μg/L均低于术前( 51.19±4.38) μg/L、(16.50±1.45)ng/L、(18.26±2.29)μg/L;预后良好组入院 1周、术后 6个月血清 HIF-1α(40.78±1.53)μg/L和( 34.87±4.68)μg/ L、ET-1(13.12±2.16)ng/L和( 10.05±1.96)ng/L、MMP-9(14.87±1.20)μg/L和( 12.21±2.87)μg/L均低于术前( 47.82±4.13)μg/L、(14.89±2.75)ng/L、(17.41±1.21)μg/L;预后良好组术后 6个月血清 HIF-1α、ET-1、MMP-9水平均低于入院 1周( P<0.05)。预后不良组术前、入院 1周、术后 6个月血清 HIF-1α、ET-1、MMP-9水平均高于预后良好组( P<0.05)。预后不良组多发动脉瘤、脑积水、 Hunt-Hess分级 Ⅳ~Ⅴ级、 CT Fisher分级 3~4级、手术时机为 ≥72 h、并发脑血管痉挛、并发脑梗死病人占比均高于预后良好组( P<0.05); Hunt-Hess分级 Ⅳ~Ⅴ级、手术时机为 ≥72 h、术前及入院 1周血清 HIF-1α、ET-1、MMP-9高水平均是颅内动脉瘤破裂出血预后不良的危险因素( P<0.05);受试者操作特征曲线显示,术前及入院 1周血清 HIF-1α、ET-1、MMP-9三者联合预测颅内动脉瘤破裂出血病人预后不良的灵敏度( 97.56%、95.12%)和曲线下面积( 0.93、0.91)高于单独预测( P<0.05)特异度与单独评估比较差异无统计学意义( P>0.05)。结论颅内动脉瘤破裂出血病人术前血清 HIF-1α、ET-1、MMP-9水平均,高于健康人群,术前和入院 1周血清 HIF-1α、ET-1、MMP-9高水平均是术后预后不良的独立危险因素,且对颅内动脉瘤破裂出血术后预后不良具有一定预测价值,但三者联合预测价值更高。
英文摘要:
      Objective To investigate the value of serum hypoxia-inducible factor-1α (HIF-1α), endothelin-1 (ET-1), and matrix me talloproteinase-9 (MMP-9) combined in predicting poor prognosis after intracranial aneurysm rupture hemorrhage.Methods A total of 142 patients with ruptured intracranial aneurysm hemorrhage admitted to Dongtai People's Hospital from January 2020 to January2022 were selected as the study group, and another 140 healthy people who underwent medical checkups during same period were selected as the control group. The serum levels of HIF-1α, ET-1 and MMP-9 before the operation, 1 week after admission (all postoperative) and 6 months after the operation were detected and compared. In addition, patients were divided into a good prognosis group (101patients) and a poor prognosis group (41 patients) according to the prognosis 6 months after discharge, and the serum levels of HIF-1α, ET-1 and MMP-9 were compared between the good prognosis group and the poor prognosis group preoperatively, at 1 week after admission, and at 6 months postoperatively. To analyze the factors influencing the poor prognosis of patients with intracranial ruptured aneurysm hemorrhage and the predictive value of serum HIF-1α, ET-1, and MMP-9 alone and in combination for the poor prognosis of pa tients with intracranial ruptured aneurysm hemorrhage.Results The preoperative serum levels of HIF-1α, ET-1 and MMP-9 in the study group were greater than those in the control group (P<0.05). The incidence of poor prognosis in the study group was 28.87% (41/ 142) at the 6-month follow-up, and the levels of serum HIF-1α, ET-1 and MMP-9 were significantly different according to repeated-measures ANOVA (P<0.05). In the poor prognosis group, the serum HIF-1α [(42.43±3.05) μg/L and (41.53±4.52) μg/L] and ET-1 [(14.27±1.24) ng/L and (13.96±2.04) ng/L] levels at 1 week after admission and 6 after admission and the MMP-9 [(15.57±1.81) μg/Land (14.68±2.65) μg/L] level were lower than the preoperative level [(51.19±4.38) μg/L, (16.50±1.45) ng/L, and (18.26±2.29) μg/L, respectively]. In the good prognosis group, the serum HIF-1α [(40.78±1.53) μg/L and (34.87±4.68) μg/L] levels at 1 week after admission and 6 months after surgery and the ET-1 [(13.12±2.16) ng/L and (10.05±1.96) ng/L] and MMP-9 [(14.87±1.20) μg/L and (12.21±2.87)μg/L] levels were lower than the preoperative levels [(47.82±4.13) μg/L, (14.89±2.75) ng/L, and (17.41±1.21) μg/L, respectively]. Serum HIF-1α, ET-1, and MMP-9 levels were lower in the good prognosis group than in the admission group 1 week after surgery (P< 0.05). Serum HIF-1α, ET-1, and MMP-9 levels were greater in the poor prognosis group than in the good prognosis group preoperatively, at 1 week after admission, and at 6 months after surgery (P<0.05). The percentages of patients with multiple aneurysms, hydrocepha lus, Hunt–Hess classification Ⅳ-Ⅴ, CT Fisher classification 3-4, timing of surgery for ≥72 h, concurrent cerebral vasospasm, and concurrent cerebral infarction were greater in the poor prognosis group than in the good prognosis group (P<0.05). Hunt–Hess classifica tion grades Ⅳ-Ⅴ, a surgical duration of ≥72 h, and high levels of serum HIF-1α, ET-1, and MMP-9 levels before surgery and 1 weekafter admission were risk factors for a poor prognosis in patients with ruptured intracranial aneurysm hemorrhage (P<0.05). The receiver operating characteristic curves showed that the sensitivity (97.56%, 95.12%) and area under the curve (0.93, 0.91) of the combination of preoperative and 1-week admission serum HIF-1α, ET-1, and MMP-9 levels in predicting poor prognosis in patients with intracranial aneurysm rupture hemorrhage were greater than those of the prediction alone (P<0.05), and the difference in specificity was notstatistically significant when compared with the assessment alone (P>0.05). Conclusions The serum levels of serum HIF-1α, ET-1 and MMP-9 in patients who experienced intracranial aneurysm rupture hemorrhage before surgery were greater than those in thehealthy controls, and high serum levels of serum HIF-1α, ET-1 and MMP-9 before surgery and 1 week after admission were found to beindependent risk factors for poor prognosis after surgery. These factors had a certain predictive value for poor prognosis after operationof intracranial aneurysm rupture hemorrhage, but the combination of all three factors had a greater predictive value.
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