标题：急性脑出血后血肿腔引流液及外周血CRP、TNF-α和MMP-9水平与脑水肿体积及临床预后的关系

      作者：冯天保 1，许超 1，陈真 2    1.延安大学附属医院心脑血管医院放射科，陕西 延安 716000；2.延安市人民医院放射科，陕西 延安 716000

      卷次： 2023年34卷9期

      【摘要】 目的 分析急性脑出血(ACH)后血肿腔引流液及外周血C反应蛋白(CRP)、肿瘤坏死因子α (TNF-α)、基质金属蛋白酶9 (MMP-9)水平与脑水肿体积及患者临床预后的关系。方法 选取2015年3月至2020年4月延安大学附属医院心脑血管医院收治的98例ACH患者为研究对象，检测其术后第1天、第3天血肿腔引流液及外周血CRP、TNF-α、MMP-9水平，通过头颅CT测得患者脑水肿体积，采用 Pearson相关性分析法分析CRP、TNF-α、MMP-9与脑水肿体积的相关性，按3个月后患者的格拉斯哥结局量表(GOS)评分分为预后不良组(n=56)与预后良好组(n=42)，使用Logistic回归分析法分析影响患者预后的危险因素。结果 术后第 3天，患者的脑水肿体积为(12.48±2.05) mL，大于术后第1天的(4.16±0.57) mL，差异有统计学意义(P<0.05)；术后第3天，患者血肿腔引流液中的CRP、TNF-α和MMP-9分别为(21.59±3.63) mg/L、(167.56±20.47) ng/L、(142.23±23.38) ?g/L，明显高于术后第1天的(18.37±2.35) mg/L、(119.18±17.35) ng/L、(110.42±19.86) ?g/L，差异均有统计学意义(P<0.05)；术后第3天，患者外周血中的CRP、TNF-α和MMP-9分别为(19.87±2.85) mg/L、(159.04±21.67) ng/L、(138.06±22.45) ?g/L，明显高于术后第1天的(16.05±2.24) mg/L、(112.36±15.18) ng/L、(105.71±16.24) ?g/L，差异均有统计学意义(P<0.05)；经Pearson相关性分析结果显示，血肿腔引流液及外周血CRP、TNF-α、MMP-9水平与脑水肿体积呈正相关(P<0.05)；预后不良组患者的脑出血量、脑水肿体积明显大于预后良好组，血肿腔引流液及外周血的CRP、TNF-α、MMP-9水平明显高于预后良好组，差异均有统计学意义(P<0.05)；经 Logistic回归分析结果显示，血肿腔引流液及外周血CRP、TNF-α、MMP-9、出血量、脑水肿体积均为影响预后独立的危险因素(P<0.05)。结论 ACH后血肿腔引流液及外周血CRP、TNF-α、MMP-9表达水平与脑水肿体积呈显著正相关，且为患者预后危险因素。
      【关键词】 急性脑出血；脑水肿；C反应蛋白；肿瘤坏死因子α；基质金属蛋白酶9；相关性
      【中图分类号】 R743.34 【文献标识码】 A 【文章编号】 1003—6350（2023）09—1233—05

Relationship of CRP, TNF-α, and MMP-9 in hematoma cavity drainage fluid and peripheral blood after acutecerebral hemorrhage with cerebral edema volume and clinical prognosis.
FENG Tian-bao 1, XU Chao 1, CHEN Zhen 2.1. Department of Radiology, Cardiovascular Hospital, Affiliated Hospital of Yan'an University, Yan'an 716000, Shaanxi,CHINA; 2. Department of Radiology, Yan'an People's Hospital, Yan'an 716000, Shaanxi, CHINA
【Abstract】 Objective To analyze the relationship of C-reactive protein (CRP), tumor necrosis factor α(TNF-α), and matrix metalloproteinase 9 (MMP-9) levels in hematoma cavity drainage fluid and peripheral blood afteracute cerebral hemorrhage (ACH) with cerebral edema volume and clinical prognosis. Methods A total of 98 patientswith ACH who were admitted to Cardiovascular Hospital, Affiliated Hospital of Yan'an University from March 2015 toApril 2020 were selected as the study subjects. The levels of CRP, TNF-α, and MMP-9 in hematoma cavity drainage flu-id and peripheral blood were detected on the 1st, 3rd day after operation. The cerebral edema volume was measured byhead CT. The correlation of CRP, TNF-α, and MMP-9 with cerebral edema volume was analyzed by Pearson correlationanalysis. Three months later, the patients were divided into poor prognosis group (n=56) and good prognosis group (n=42) according to the Glasgow Outcome Scale (GOS) score. Logistic regression analysis was performed to screen the riskfactors for the prognosis. Results The cerebral edema volume on the 3rd day after operation was (12.48±2.05) mL, sig-nificantly larger than (4.16±0.57) mL on the 1st day after operation (P<0.05). The levels of CRP, TNF-α, and MMP-9 inhematoma cavity drainage fluid on the 3rd day after operation were (21.59 ± 3.63) mg/L, (167.56 ± 20.47) ng/L, and(142.23±23.38) μg/L, significantly higher than (18.37±2.35) mg/L, (119.18±17.35) ng/L, and (110.42±19.86) ?g/L onthe 1st day after operation (P<0.05). The levels of CRP, TNF-α, and MMP-9 in peripheral blood on the 3rd day after opera-tion were (19.87±2.85) mg/L, (159.04±21.67) ng/L, and (138.06±22.45) μg/L, significantly higher than (16.05±2.24) mg/L,(112.36 ± 15.18) ng/L, and (105.71 ± 16.24) ?g/L on the 1st day after operation (P<0.05). Pearson correlation analysisfound that the levels of CRP, TNF-α, and MMP-9 in hematoma cavity drainage fluid and peripheral blood were positive-ly correlated with cerebral edema volume (P<0.05). The bleeding volume and cerebral edema volume of the poor progno-sis group were larger than those of the good prognosis group. The levels of CRP, TNF-α, and MMP-9 in hematoma cavi-ty drainage fluid and peripheral blood were significantly higher than those in the good prognosis group (P<0.05). Logis-tic regression analysis found that CRP, TNF-α, and MMP-9 in hematoma cavity drainage fluid and peripheral blood,blood loss, and cerebral edema volume were independent prognostic risk factors (P<0.05). Conclusion After ACH, theexpression levels of CRP, TNF-α, and MMP-9 in hematoma cavity drainage fluid and peripheral blood are significantlypositively correlated with cerebral edema volume, and they are prognostic risk factors.
      【Key words】 Acute cerebral hemorrhage; Cerebral edema; C-reactive protein; Tumor necrosis factor alpha; Ma-trix metalloproteinase 9; Correlation