CAJ | 학술논문

目的：探讨血浆基质金属蛋白酶9（MMP-9）等因素在脑出血后迟发性脑水肿形成中的临床意义。方法回顾性分析107例接受内科保守治疗的自发性脑出血患者的临床资料，根据临床特点及影像学变化分为迟发性脑水肿组（病例组39例）和非迟发性脑水肿组（对照组68例）；于发病24 h内用酶联免疫吸附法测定血浆MMP-9水平，在住院后第1、2周复查头部CT，监测血肿及水肿体积变化。将可能影响脑出血后迟发性脑水肿形成的相关因素先进行单因素分析，单因素分析显示差异有统计学意义的变量纳入多因素Logistic回归分析。结果病例组患者血浆MMP-9水平明显高于对照组[分别为（189±51）和（118±27）mg／L]，差异有统计学意义（P＜0.01）。单因素分析结果显示，两组患者年龄、吸烟史、血糖水平、基线血肿体积、入院时美国国立卫生研究卒中量表（NIHSS）评分差异有统计学意义（均 P＜0．05）；Logistic回归分析结果显示，MMP-9水平（OR＝9.745，95％CI：6.754～15.466，P＜0.01）、基线出血体积（OR ＝2.411，95％CI：1.190～2.728，P＝0.018）、入院时血糖水平（OR＝1.327，95％CI：1.133～1.850，P＝0.004）、NIHSS评分（OR＝1.867，95％CI：1.272～2.364，P ＝0.020）为脑出血后迟发性脑水肿形成的独立危险因素。结论自发性脑出血患者出血量、NIHSS评分、高血糖可能是脑出血后迟发性脑水肿形成的危险因素，而入院时高MMP-9水平提示迟发性脑水肿形成的风险较高。
목적：탐토혈장기질금속단백매9（MMP-9）등인소재뇌출혈후지발성뇌수종형성중적림상의의。방법회고성분석107례접수내과보수치료적자발성뇌출혈환자적림상자료，근거림상특점급영상학변화분위지발성뇌수종조（병례조39례）화비지발성뇌수종조（대조조68례）；우발병24 h내용매련면역흡부법측정혈장MMP-9수평，재주원후제1、2주복사두부CT，감측혈종급수종체적변화。장가능영향뇌출혈후지발성뇌수종형성적상관인소선진행단인소분석，단인소분석현시차이유통계학의의적변량납입다인소Logistic회귀분석。결과병례조환자혈장MMP-9수평명현고우대조조[분별위（189±51）화（118±27）mg／L]，차이유통계학의의（P＜0.01）。단인소분석결과현시，량조환자년령、흡연사、혈당수평、기선혈종체적、입원시미국국립위생연구졸중량표（NIHSS）평분차이유통계학의의（균 P＜0．05）；Logistic회귀분석결과현시，MMP-9수평（OR＝9.745，95％CI：6.754～15.466，P＜0.01）、기선출혈체적（OR ＝2.411，95％CI：1.190～2.728，P＝0.018）、입원시혈당수평（OR＝1.327，95％CI：1.133～1.850，P＝0.004）、NIHSS평분（OR＝1.867，95％CI：1.272～2.364，P ＝0.020）위뇌출혈후지발성뇌수종형성적독립위험인소。결론자발성뇌출혈환자출혈량、NIHSS평분、고혈당가능시뇌출혈후지발성뇌수종형성적위험인소，이입원시고MMP-9수평제시지발성뇌수종형성적풍험교고。
Objective Toinvestigatetheclinicalsignificanceofplasmamatrixmetalloproteinase9 (MMP-9)intheformationofdelayedcerebraledemaafterintracerebralhemorrhage.Methods The clinical data of 107 patients with spontaneous intracerebral hemorrhage treated with conservative medical treatment were analyzed retrospectively. According to the clinical features and imaging changes,they were divided into either a delayed cerebral edema group (case group n=39)or a non-delayed cerebral edema group (control group n =68 ). The plasma MMP-9 level was detected with enzyme-linked immunosorbent assay within 24 h after onset. The patients performed head CT scan again at day 7 and 14 after admission. The changes of hematoma and edema volume were detected. All the possible factors associated with the formation of delayed cerebral edema were firstly analyzed by the univariate analysis. Univariate analysis showed that the variables with significant differences were enrolled into multiple logistic regression analysis. Results TheplasmaMMP-9levelofthedelayedbrainedemagroupwassignificantlyhigherthanthatof the control group,they were 189 ± 51 and 118 ± 27 mg/L respectively (P<0. 01). The result of univariate analysis showed that age,history of smoking,blood glucose level,baseline hematoma volume,and National Institute of Health stroke scale (NIHSS )score on admission might be associated with the formation of delayed cerebral edema after intracerebral hemorrhage. Logistic regression analysis showed that MMP-9 level (OR,9. 745,95%CI 6. 754-15. 466,P<0. 01),baseline hematoma volume (OR,2. 411,95%CI 1. 190-2. 728,P =0. 018),blood glucose level on admission (OR,1. 327,95%CI 1. 133 -1. 850,P =0.004),and NIHSS score (OR,1. 867,95%CI 1. 272-2. 364,P=0. 020)were the independent risk factorsfortheformationofdelayedcerebraledemaafterintracerebralhemorrhage.Conclusion Theamount of bleeding,NIHSS score,and hyperglycemia are the risk factors for the formation of delayed cerebral edema in patients with spontaneous intracerebral hemorrhage,while high MMP-9 level on admission indicated that the risk of the formation of delayed cerebral edema is high.