基质金属蛋白酶9和胱抑素C水平与急性脑梗死患者颈动脉粥样硬化斑块稳定性的关系研究

摘要

目的 分析基质金属蛋白酶9(MMP-9)和胱抑素C(Cys-C)水平与急性脑梗死(ACI)患者颈动脉粥样硬化斑块稳定性的关系.方法 选取2016年1—9月新疆医科大学第五附属医院神经内科收治的ACI患者189例作为观察组,另选取同期于新疆医科大学第五附属医院体检健康者80例作为对照组.比较两组受试者一般资料和实验室检查指标,MMP-9、Cys-C与ACI患者颈动脉粥样硬化斑块稳定性的关系分析采用有序Logistic回归分析,绘制ROC曲线以评价MMP-9、Cys-C对ACI患者颈动脉粥样硬化斑块稳定性的预测价值.结果 两组受试者性别、年龄、高血压病史、空腹血糖(FBG)比较,差异无统计学意义(P>0.05);观察组患者MMP-9、Cys-C水平高于对照组(P<0.05).观察组患者中发现不稳定性颈动脉粥样硬化斑块较多者83例(占43.9%),稳定性颈动脉粥样硬化斑块较多者67例(占35.5%),无颈动脉粥样硬化斑块者39例(占20.6%).有序Logistic回归分析结果显示,MMP-9、Cys-C水平较低的ACI患者颈动脉粥样硬化斑块稳定性优于MMP-9、Cys-C水平较高者(P<0.05).绘制ROC曲线发现,MMP-9预测ACI患者颈动脉粥样硬化斑块稳定性的曲线下面积为0.932〔95%CI(0.896,0.968)〕,最佳截断值为7.96 mmol/L,灵敏度为1.000,特异度为0.750,约登指数为0.075;Cys-C预测ACI患者颈动脉粥样硬化斑块稳定性的曲线下面积为0.794〔95%CI(0.732,0.857)〕,最佳截断值为0.75 mmol/L,灵敏度为0.756,特异度为0.701,约登指数为0.457.结论 MMP-9、Cys-C水平与ACI患者颈动脉粥样硬化斑块稳定性有关,二者对ACI患者颈动脉粥样硬化斑块稳定性的预测价值均较高.%Objective To analyze the relationship between MMP-9,Cys-C and carotid atherosclerostic plaques stability in patients with acute cerebral infarction.Methods From January to September 2016,a total of 189 patients with acute cerebral infarction were selected as observation group in the Department of Neurology,the Fifth Affiliated Hospital of Xinjiang Medical University,meanwhile 80 healthy people admitted to this hospital for physical examination were selected as control group.General information and laboratory examination results were compared between the two groups,relationship between MMP-9,Cys-C and carotid atherosclerostic plaques stability was analyzed by ordinal Logistic regression analysis,ROC curve was drawn to evaluate the predictive value of MMP-9 and Cys-C in predicting carotid atherosclerostic plaques stability.Results No statistically significant differences of gender,age,hypertension history or FBG was found between the two groups(P>0.05), while MMP-9 and Cys-C in observation group were statistically significantly higher than those in control group(P<0.05).Of observation group,83 cases found mainly unstable carotid atherosclerostic plaques(accounting for 43.9%),67 cases found mainly stable carotid atherosclerostic plaques(accounting for 35.5%),39 cases did not found carotid atherosclerostic plaque (accounting for 20.6%).Ordinal Logistic regression analysis results showed that,carotid atherosclerostic plaques stability in acute cerebral infarction patients with reduced MMP-9 and Cys-C was statistically significantly better than that in acute cerebral infarction patients with elevated MMP-9 and Cys-C(P<0.05).ROC curve showed that,AUC of MMP-9 in predicting carotid atherosclerostic plaques stability in patients with acute cerebral infarction was 0.932〔95%CI(0.896,0.968)〕,the optimum truncation value was 7.96 mmol/L,the sensitivity was 1.000,the specificity was 0.075,the Youden index was 0.075;AUC of Cys-C in predicting carotid atherosclerostic plaques stability in patients with acute cerebral infarction was 0.794〔95%CI(0.732, 0.857)〕,the optimum truncation value was 0.75 mmol/L,the sensitivity was 0.756,the specificity was 0.701,the Youden index was 0.457.Conclusion MMP-9 and Cys-C are significantly correlated with carotid atherosclerostic plaques stability in patients with acute cerebral infarction,have relatively high predictive value on carotid atherosclerostic plaques stability.