【摘要】 目的 探索MMP-9及IL-6、TNF-α在急性缺血性脑卒中（AIS）患者静脉溶栓治疗后出血转化（HT）中的意义。方法 收集2021-01—2022-12在郑州市第一人民医院神经内科住院的AIS并给予静脉溶栓治疗的患者122例，依据患者静脉溶栓结局有无发生HT分为HT组与非HT组，检测入院第1、3、7天时患者血清MMP-9水平，入院第1天IL-6、TNF-α水平，分析相关临床资料在AIS静脉溶栓治疗后HT中的意义。结果 单因素分析中，2组间溶栓后非颅内出血、治疗前及溶栓后NIHSS评分、FBG、NEUT%、Hcy、LDL-C、MMP-9、IL-6、TNF-α差异均有统计学意义（P<0.05）。Logistic回归分析发现，溶栓后非颅内出血及血清MMP-9、IL-6、TNF-α、Hcy、LDL-C等与AIS静脉溶栓治疗后HT的发生独立相关（P<0.05），其中溶栓后非颅内出血与血清MMP-9、IL-6、TNF-α是危险因素，Hcy、LDL-C水平为阻碍因素。ROC曲线分析显示MMP-9、TNF-α、IL-6及其联合对HT的发生均有预测价值，以MMP-9最为可靠，预测AIS静脉溶栓治疗后HT发生的AUC为0.907，界值109.25μg/L，灵敏度93.8%，特异性76.4%。结论 血清MMP-9及IL-6、TNF-α单独与联合检测均可预测AIS患者静脉溶栓后HT的发生。更多还原

【Abstract】 Objective To investigate the significance of MMP-9, IL-6 and TNF-α in hemorrhage transformation(HT)after intravenous thrombolytic therapy for patients with AIS.Methods A total of 122 AIS patients treated by intravenous thrombolysis in the Department of Neurology,Zhengzhou First People’s Hospital from January 2021 to December 2022 were collected. According to the outcome of intravenous thrombolysis,the patients were divided into HT group and non-HT group. The serum MMP-9 concentration on the 1st,3rd and 7th day after admission was detected. The concentrations of IL-6 and TNF-α on the first day of admission,the relevant clinical data were statistically analyzed,and their significance in HT after intravenous thrombolysis in AIS was analyzed.Results In the univariate analysis,there were significant differences in non-intracranial hemorrhage after thrombolysis,NIHSS score before and after thrombolysis,FBG,NEUT%,Hcy,LDL-C,MMP-9, IL-6 and TNF-α between the two groups(P<0.05). Logistic regression analysis showed that non-intracranial hemorrhage after thrombolysis,serum MMP-9,IL-6,TNF-α,Hcy and LDL-C levels were independently correlated with the occurrence of HT after intravenous thrombolysis in AIS(P<0.05). Non-intracranial hemorrhage after thrombolysis,serum MMP-9,IL-6 and TNF-α were risk factors,and Hcy and LDL-C levels were hindering factors for HT. ROC curve analysis showed that MMP-9,TNF-α,IL-6 and their combination had predictive value for the occurrence of HT,and MMP-9 level was the most reliable. The AUC of predicting HT after AIS intravenous thrombolysis was 0.907,the cut-off value was 109.25 μg/L,the sensitivity was 93.8%,and the specificity was 76.4%.Conclusion Serum MMP-9,IL-6 and TNF-α and combined detection can predict the occurrence of HT after intravenous thrombolysis in AIS patients.更多还原