Department of Neurology, People's Hospital of Deyang City, Deyang, China.
Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Brain Behav. 2019 Jun;9(6):e01291. doi: 10.1002/brb3.1291. Epub 2019 Apr 22.
The mechanisms of ischemic stroke severity and early neurologic deterioration (END) are not fully understood. The aim of the present study was to investigate the association of six variants in MMP-9 gene with ischemic stroke severity and the risk for END in ischemic stroke (IS) patients with atrial fibrillation (AF).
This was a multi-center, prospective, observational study of 615 acute IS patients with AF admitted to six participating hospitals between June 2016 and October 2017. Ischemic stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) score on admission. END was defined as an increase of four or more points in NIHSS within 10 days of admission. Six variants of MMP-9 gene were examined using mass spectrometry.
Among the 615 enrolled patients, 112 (18.2%) patients presented with moderate or severe stroke (NIHSS score ≥16), and 108 (17.6%) patients suffered from END within 10 days of admission. Multiple logistic analysis showed that prestroke antiplatelet therapy, prestroke anticoagulant therapy, rs3918242 CT/TT, and rs3787268 AG/GG were independent predictors for stroke severity. Cox proportional hazard regression revealed that diabetes mellitus, prestroke antiplatelet therapy, prestroke anticoagulant therapy, rs1056628 AC/CC, and rs3918242 CT/TT were independently associated with the risk of END.
The incidence of moderate or severe stroke and END was very common in acute IS patients with AF. MMP-9 polymorphisms were independently associated with severe stroke and higher risk of END, and prestroke antithrombotic treatment was associated with less severe stroke and lower risk of END in patients with AF.
缺血性脑卒中严重程度和早期神经功能恶化（END）的机制尚未完全阐明。本研究旨在探讨基质金属蛋白酶-9（MMP-9）基因 6 个变异与伴有心房颤动（AF）的缺血性脑卒中（IS）患者的卒中严重程度和 END 风险之间的关系。
这是一项多中心、前瞻性、观察性研究，纳入 2016 年 6 月至 2017 年 10 月期间入住 6 家参与医院的 615 例急性 IS 合并 AF 患者。入院时采用美国国立卫生研究院卒中量表（NIHSS）评分评估缺血性脑卒中严重程度。入院后 10 天内 NIHSS 评分增加 4 分或更多定义为 END。采用质谱法检测 MMP-9 基因的 6 个变异。
在纳入的 615 例患者中，112 例（18.2%）患者为中度或重度卒中（NIHSS 评分≥16），108 例（17.6%）患者在入院后 10 天内发生 END。多因素 logistic 分析显示，卒中前抗血小板治疗、卒中前抗凝治疗、rs3918242 CT/TT 和 rs3787268 AG/GG 是卒中严重程度的独立预测因素。Cox 比例风险回归分析显示，糖尿病、卒中前抗血小板治疗、卒中前抗凝治疗、rs1056628 AC/CC 和 rs3918242 CT/TT 与 END 的风险独立相关。
AF 合并急性 IS 患者中，中度或重度卒中及 END 的发生率非常高。MMP-9 多态性与严重卒中及 END 风险增加独立相关，而卒中前抗血栓治疗与 AF 患者较轻的卒中严重程度和较低的 END 风险相关。
