血清CTRP-3、MMP-9、TRAF6水平联合检测对急性脑梗死患者溶栓后出血转化的预测价值

Predictive Value of Combined Detection of Serum CTRP-3, MMP-9, and TRAF6 Levels for Hemorrhagic Transformation after Thrombolysis in Patients with Acute Cerebral Infarction

摘要

目的 探讨血清补体C1q肿瘤坏死因子相关蛋白3（CTRP-3）、基质蛋白金属酶-9（MMP-9）、肿瘤坏死因子受体相关因子（TRAF6）水平联合检测对急性脑梗死患者溶栓后出血转化（HT）的预测价值。方法 选取南阳市第一人民医院2021年1月~2024年1月收治的107例急性脑梗死患者,依据溶栓后24 h是否发生HT分为HT组（22例）、非HT组（85例）。比较2组入院时血清CTRP-3、MMP-9、TRAF6水平、美国国立卫生研究院卒中量表（NIHSS）评分并分析相关性,分析血清指标联合检测对溶栓后发生HT的预测价值及不同血清水平患者溶栓后发生HT的情况。结果 与非HT组相比,HT组血清CTRP-3水平较低,血清MMP-9、TRAF6水平、NIHSS评分较高,差异有统计学意义（P<0.05）;血清CTRP-3水平与NIHSS评分呈负相关,血清MMP-9、TRAF6水平与NIHSS评分呈正相关,差异有统计学意义（P<0.05）;血清CTRP-3、MMP-9、TRAF6水平联合预测溶栓后HT的曲线下面积（AUC）为0.934,约登指数为0.744,敏感度、特异度分别为90.91%、83.53%,差异有统计学意义（P<0.05）;血清CTRP-3、MMP-9、TRAF6高水平患者溶栓后发生HT的危险度分别是低水平患者的0.113倍、12.487倍、8.172倍,差异有统计学意义（P<0.05）。结论 血清CTRP-3、MMP-9、TRAF6水平与急性脑梗死患者溶栓后HT的发生有关,三者联合检测可为急性脑梗死患者溶栓后HT的临床预测提供参考。

Abstract

Objective To investigate the predictive value of combined detection of serum complement C1q tumor necrosis factor-related protein 3 (CTRP-3), matrix metalloproteinase-9 (MMP-9), and tumor necrosis factor receptor-associated factor 6 (TRAF6) levels for hemorrhagic transformation (HT) after thrombolysis in patients with acute cerebral infarction. Methods A total of 107 patients with acute cerebral infarction admitted to the First People's Hospital of Nanyang City from January 2021 to January 2024 were selected. They were divided into the HT group (22 cases) and the non-HT group (85 cases) based on whether HT occurred within 24 hours after thrombolysis. The levels of serum CTRP-3, MMP-9, and TRAF6, as well as the National Institutes of Health Stroke Scale (NIHSS) scores, were compared between the two groups at admission, and their correlation was analyzed. The predictive value of combined serum indicators detection for HT occurrence after thrombolysis and the incidence of HT in patients with different serum levels after thrombolysis were also analyzed. Results Compared with the non-HT group, the HT group had lower serum CTRP-3 levels, higher serum MMP-9, TRAF6 levels, and NIHSS scores, with statistically significant differences (P<0.05). Serum CTRP-3 levels were negatively correlated with NIHSS scores, while serum MMP-9 and TRAF6 levels were positively correlated with NIHSS scores, with statistically significant differences (P<0.05). The area under the curve (AUC) for the combined prediction of post-thrombolysis HT using serum CTRP-3, MMP-9, and TRAF6 levels was 0.934, with a Youden's index of 0.744, and sensitivity and specificity of 90.91% and 83.53%, respectively, with statistically significant differences (P<0.05). The risk of post-thrombolysis HT in patients with high levels of serum CTRP-3, MMP-9, and TRAF6 was 0.113 times, 12.487 times, and 8.172 times than that in patients with low levels, respectively, with statistically significant differences (P<0.05). Conclusion The levels of serum CTRP-3, MMP-9, and TRAF6 are associated with the occurrence of HT after thrombolysis in patients with acute cerebral infarction. Combined detection of these three factors can provide a reference for clinical prediction of HT after thrombolysis in patients with acute cerebral infarction.

关键词

CTRP-3 / MMP-9 / TRAF6 / 急性脑梗死 / 出血转化

Key words

CTRP-3 / MMP-9 / TRAF6 / Acute cerebral infarction / Hemorrhagic transformation

[1] 高倩,王建宇,孟伟建,等. 急性脑梗死患者血清微小RNA-145、程序性细胞死亡因子4 mRNA水平变化及诊断价值研究[J]. 实用心脑肺血管病杂志,2022,30(2):18-23.
[2] 杨丹丹,蒋琳芝,李丽燕,等. 系统免疫炎症指数预测老年卒中病人溶栓后出血转化的价值[J]. 实用老年医学,2023,37(8):789-793.
[3] 钟凯,毛炜,周强. CT灌注成像参数与血清CTRP-3、LDL-C及MMP-9对急性脑梗死后出血转化的评价[J]. 中国医学装备,2023,20(12):62-66.
[4] 秦霜,戴才文,王根强,等. CT灌注成像联合血清D-D、MMP-9对急性脑梗死患者溶栓后出血转化的预测价值研究[J]. 中国CT和MRI杂志,2023,21(6):24-27.
[5] 高金勇,陈克尚,梁慧. 神经节苷脂对脑梗死大鼠神经炎症及TLR4/TRAF6/NF-κB信号通路的影响[J]. 现代医学,2022,50(9):1174-1178.
[6] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国急性缺血性卒中诊治指南2023[J]. 中华神经科杂志,2024,57(6):523-559.
[7] 陈建东,曾萍,林秀孟,等. 急性脑梗死溶栓后24 h血压与出血转化及神经功能预后的相关性研究[J]. 中国实验诊断学,2023,27(12):1398-1403.
[8] 周有婷,李志鹏,王嘉鹏. 急性脑梗死患者血清CTRP-3、D-二聚体、sTREM2水平及相关临床特征与溶栓后出血性转化的关系[J]. 中国现代医学杂志,2023,33(24):60-66.
[9] 冉东川,何艳,王莉华,等. 糖尿病合并动脉粥样硬化病人CTRP3的表达及其与血脂、血糖的相关性[J]. 中西医结合心脑血管病杂志,2021,19(22):3952-3955.
[10] Ding H, Wang Z, Song W.CTRP3 protects hippocampal neurons from oxygen-glucose deprivation-induced injury through the AMPK/Nrf2/ARE pathway[J]. Hum Exp Toxicol, 2021, 40(7): 1153-1162.
[11] 李明霞,李秋昉. 血清基质金属蛋白酶9对急性脑梗死溶栓后出血转化的预测价值[J]. 医学理论与实践,2024,37(4):652-654.
[12] Arba F, Piccardi B, Palumbo V, et al.Blood-brain barrier leakage and hemorrhagic transformation:The Reperfusion Injury in Ischemic StroKe(RISK)study[J]. Eur J Neurol, 2021, 28(9): 3147-3154.
[13] 郎丰龙,张强. rt-PA溶栓联合机械支架介入取栓对急性缺血性脑卒中患者炎性细胞因子和近期预后的影响[J]. 检验医学与临床,2021,18(1):104-107.
[14] 张三妮,韩淑辉. 血清TRAF6、sTLT-1和血管生成素样蛋白8对急性脑梗死出血性转化的预测效能分析[J]. 中国医科大学学报,2023,52(11):1009-1014.
[15] 翁嘉懿,殷云杰,马雪兴,等. CD137-CD137L信号通路通过活化TNF受体相关因子6促进小鼠动脉粥样硬化斑块内血管新生[J]. 天津医药,2021,49(4):384-389.