sTREM-1、MMP-9对急性大脑中动脉闭塞脑卒中患者术后无效再通的预测价值

许鹏飞; 李瑞; 谌男; 周倩倩; 王黎; 朱余友

doi:10.16766/j.cnki.issn.1674-4152.004241

sTREM-1、MMP-9对急性大脑中动脉闭塞脑卒中患者术后无效再通的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.004241

中国科学技术大学附属第一医院(安徽省立医院)神经内科，安徽合肥 230001

基金项目:

国家自然科学基金面上项目 82471310

详细信息

通讯作者:
朱余友，E-mail：zhuyuyou2020@126.com

中图分类号: R743.31
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出版历程
- 收稿日期: 2025-04-03
- 网络出版日期: 2026-01-07

sTREM-1 and MMP-9 in predicting futile recanalization after endovascular treatment in acute middle cerebral artery occlusion ischemic stroke

Department of Neurology, the First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui 230001, China

摘要

摘要: 目的分析急性大脑中动脉闭塞脑卒中(MCAO-AIS)患者机械取栓术后无效再通的影响因素，探讨血清可溶性髓样细胞触发受体-1(sTREM-1)及基质金属蛋白酶-9(MMP-9)水平对无效再通的预测价值。方法前瞻性纳入2020年8月—2022年9月在中国科学技术大学附属第一医院神经内科行机械取栓并实现再通的115例MCAO-AIS患者。根据术后3个月改良Rankin量表(mRS)评分分为有效再通组(45例)和无效再通组(70例)。采用多因素logistic回归分析探究无效再通的独立影响因素，绘制ROC曲线评估sTREM-1、MMP-9水平对无效再通的预测价值。结果与有效再通组比较，无效再通组患者年龄、入院时美国国立卫生研究院卒中量表(NIHSS)评分、血糖、中性粒细胞与淋巴细胞比值、血清sTREM-1及MMP-9水平较高，术前Alberta脑卒中计划早期计算机断层扫描评分(ASPECTs)较低(P < 0.05)。多因素logistic回归分析显示，年龄(OR=1.060，P=0.030，95% CI：1.006~1.117)、MMP-9水平(OR=1.007，P=0.019，95% CI：1.001~1.014)、sTREM-1水平(OR=1.009，P < 0.001，95% CI：1.004~1.014)是患者术后无效再通的独立影响因素。sTREM-1、MMP-9预测无效再通的AUC分别为0.837、0.763。结论年龄、血清sTREM-1及MMP-9水平是MCAO-AIS患者术后无效再通的独立影响因素；sTREM-1及MMP-9是预测无效再通的潜在生物标志物。
- 急性大脑中动脉闭塞脑卒中 /
- 机械取栓 /
- 可溶性髓样细胞触发受体-1 /
- 基质金属蛋白酶-9 /
- 无效再通
Abstract: Objective To analyze the influencing factors of futile recanalization after endovascular thrombectomy (EVT) in patients with acute middle cerebral artery occlusion stroke (MCAO-AIS), and to explore the predictive value of serum sTREM-1 and MMP-9 levels for futile recanalization. Methods A total of 115 MCAO-AIS patients who underwent EVT and achieved successful recanalization in the Department of Neurology, the First Affiliated Hospital of University of Science and Technology of China (USTC) from August 2020 to September 2022, were prospectively enrolled. The patients were divided into the meaningful recanalization and futile recanalization groups according to the mRS score 3 months after EVT. Independent influencing factors for futile recanalization were analyzed by multivariate logistic regression. The receiver operating characteristic curve was used to analyze the efficacy of sTREM-1 and MMP-9 in predicting futile recanalization. Results Compared with the meaningful recanalization group, the futile recanalization group had higher age, NIHSS score at admission, blood glucose, neutrophil-to-lymphocyte ratio, serum sTREM-1 and MMP-9 levels, and lower preoperative ASPECT score (P < 0.05). Multivariate logistic regression analysis showed that age (OR=1.060, P=0.030, 95% CI: 1.006-1.117), serum MMP-9 level (OR=1.007, P=0.019, 95% CI: 1.001-1.014), and serum sTREM-1 level (OR=1.009, P < 0.001, 95% CI: 1.004-1.014) were independent influencing factors for post-procedural futile recanalization. The AUC of sTREM-1 and MMP-9 for predicting futile recanalization were 0.837 and 0.763, respectively. Conclusion Age, serum sTREM-1 and MMP-9 level are independent influencing factors for futile recanalization in MCAO-AIS patients after EVT. sTREM-1 and MMP-9 are potential biomarkers for predicting futile recanalization.
- Acute middle cerebral artery occlusion ischemic stroke /
- Mechanical thrombectomy /
- sTREM-1 /
- MMP-9 /
- Futile recanalization

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图 1 血清sTREM-1、MMP-9水平以及两指标联合预测MCAO-AIS患者EVT后无效再通的ROC曲线

Figure 1. ROC curves of serum sTREM-1, MMP-9, and their combination for predicting futile recanalization

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表 1 有效再通组与无效再通组MCAO-AIS患者基线资料比较

Table 1. Comparison of baseline characteristics between MCAO-AIS patients in the meaningful recanalization group and the futile recanalization group

组别	例数	年龄 (x±s，岁)	性别 (男性/女性，例)	高血压 [例(%)]	糖尿病 [例(%)]	冠心病 [例(%)]	心房颤动 [例(%)]	既往脑卒中/TIA[例(%)]	吸烟史 [例(%)]	饮酒史 [例(%)]	静脉溶栓 [例(%)]
有效再通组	45	62.60±13.32	25/20	27(60.0)	3(6.7)	8(17.8)	10(22.2)	2(4.4)	8(17.8)	6(13.3)	17(37.8)
无效再通组	70	70.21±11.34	33/37	37(52.9)	13(18.6)	6(8.6)	19(27.1)	11(15.7)	8(11.4)	8(11.4)	27(38.6)
统计量		3.280^a	0.775^b	0.566^b	3.241^b	2.171^b	0.352^b	3.470^b	0.922^b	0.093^b	0.007^b
P值		0.001	0.379	0.452	0.072	0.141	0.553	0.063	0.337	0.760	0.932

组别	例数	收缩压 (x±s，mmHg)	舒张压 (x±s，mmHg)	入院时ASPECTs评分 [M(P₂₅, P₇₅), 分]		入院时NIHSS评分 [M(P₂₅, P₇₅), 分]		穿刺至再通时间 [M(P₂₅, P₇₅)，min]	脑卒中类型[例(%)]
组别	例数	收缩压 (x±s，mmHg)	舒张压 (x±s，mmHg)	入院时ASPECTs评分 [M(P₂₅, P₇₅), 分]		入院时NIHSS评分 [M(P₂₅, P₇₅), 分]		穿刺至再通时间 [M(P₂₅, P₇₅)，min]	大动脉粥样硬化型	心源性栓塞型	其他类型
有效再通组	45	145.11±18.36	84.93±13.02	10(9, 10)		14.00(10.50, 17.00)		65.0(50.0, 85.0)	23(51.1)	19(42.2)	3(6.7)
无效再通组	70	147.27±23.29	84.16±12.83	9(8, 10)		18.00(12.75, 20.00)		70.0(52.5, 90.0)	31(44.3)	35(50.0)	4(5.7)
统计量		0.526^a	0.315^a	-3.637^c		-2.888^c		-0.795^c	0.599^c
P值		0.600	0.753	＜0.001		0.004		0.427	0.549
注：^a为t值，^b为χ²值，^c为Z值；1 mmHg=0.133 kPa。

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表 2 2组MCAO-AIS患者sTREM-1水平及其他实验室指标比较

Table 2. Comparison of sTREM-1 levels and other laboratory indicators between the two groups of MCAO-AIS patients

组别	例数	胱抑素C [M(P₂₅, P₇₅), mg/L]	D-二聚体 [M(P₂₅, P₇₅), mg/L]	血糖 [M(P₂₅, P₇₅), mmol/L]	白细胞 (x±s，×10⁹/L)	中性粒细胞 (x±s，×10⁹/L)
有效再通组	45	0.92(0.78, 1.11)	0.79(0.40, 2.34)	6.60(5.85, 8.24)	8.33±2.34	6.66±2.30
无效再通组	70	0.93(0.81, 1.10)	1.42(0.73, 2.54)	7.90(6.45, 9.25)	8.71±3.17	7.16±3.19
统计量		-0.109^a	-1.848^a	-2.378^a	0.753^b	0.977^b
P值		0.913	0.065	0.017	0.453	0.331

组别	例数	单核细胞 [M(P₂₅, P₇₅), 10⁹/L]	淋巴细胞 (x±s，10⁹/L)	NLR (x±s)	MMP-9 [M(P₂₅, P₇₅), ng/mL]	sTREM-1 [M(P₂₅, P₇₅), pg/L]
有效再通组	45	0.36(0.28, 0.52)	1.18±0.51	7.14±4.60	149.96(107.59, 194.57)	232.03(185.59, 295.05)
无效再通组	70	0.35(0.19, 0.56)	1.10±0.68	9.26±6.14	250.84(157.20, 394.12)	389.91(279.26, 579.16)
统计量		-0.694^a	0.713^b	2.116^b	-4.742^a	-6.089^a
P值		0.488	0.477	0.037	＜0.001	＜0.001
注：^a为Z值，^b为t值。

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表 3 MCAO-AIS患者术后无效再通影响因素的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of futile recanalization in MCAO-AIS patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.058	0.027	4.696	0.030	1.060	1.006~1.117
糖尿病	0.441	1.045	0.178	0.673	1.554	0.200~12.053
既往脑卒中/TIA	1.820	0.969	3.527	0.060	6.173	0.924~41.263
ASPECTs评分	-0.267	0.234	1.301	0.254	0.766	0.484~1.211
入院时NIHSS评分	0.054	0.058	0.868	0.351	1.056	0.942~1.183
血糖	-0.168	0.120	1.979	0.159	0.845	0.669~1.068
D-二聚体	0.088	0.074	1.428	0.232	1.092	0.945~1.261
NLR	0.017	0.056	0.088	0.766	1.017	0.911~1.136
MMP-9	0.007	0.003	5.500	0.019	1.007	1.001~1.014
sTREM-1	0.009	0.002	12.722	＜0.001	1.009	1.004~1.014

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表 4 sTREM-1、MMP-9水平预测MCAO-AIS患者EVT后无效再通影响因素的预测价值

Table 4. ROC curve analysis of serum sTREM-1 and MMP-9 levels for predicting futile recanalization

项目	AUC(95% CI)	P值	最佳截断值	灵敏度 (%)	特异度 (%)
sTREM-1(pg/mL)	0.837(0.764~0.910)	＜0.001	346.97	67.1	91.1
MMP-9(ng/mL)	0.763(0.676~0.849)	＜0.001	243.39	52.9	93.3
sTREM-1+MMP-9	0.866(0.798~0.933)	＜0.001		84.3	77.8

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