关键词: 全麻颅内动脉瘤夹闭术, 基质金属蛋白酶2, 髓过氧化物酶, 神经轴突导向因子3E, 预后, 预测价值

Abstract:

Objective To explore the predictive value of serum matrix metalloproteinase-2 （MMP-2）， myeloperoxidase （MPO）， and axonal guidance factor 3E （Sema3E） in predicting the prognosis of patients undergoing intracranial aneurysm clipping surgery under general anesthesia. Methods A total of 125 patients who underwent general anesthesia for intracranial aneurysm clipping surgery at Zhangjiakou First Hospital from May 2023 to May 2025 were selected as the study subjects. Patients with Glasgow Outcome Scale （GOS） scores ranging from 1 to 3 one month after surgery were included in the poor prognosis group （29 cases）， while those with scores from 4 to 5 were included in the good prognosis group （96 cases）. The clinical data and the levels of serum MMP-2， MPO， and Sema3E were compared between the two groups. Multivariate logistic regression analysis was used to analyze the risk factors for poor prognosis in patients undergoing general anesthesia for intracranial aneurysm clipping surgery. Receiver Operating Characteristic （ROC） curves were employed to analyze the predictive value of serum MMP-2， MPO， and Sema3E for the prognosis of patients undergoing intracranial aneurysm clipping under general anesthesia. The levels of serum MMP-2， MPO， and Sema3E among patients with different clinical characteristics were compared. Spearman correlation analysis was conducted to investigate the correlation between serum MMP-2， MPO， and Sema3E and clinical features. Results The proportions of patients with Hunt-Hess grade Ⅲ and preoperative Glasgow Coma Scale （GCS） score < 8 in the poor prognosis group were 27.59% and 51.72%， respectively， which were higher than the 10.42% and 5.21% in the good prognosis group （P < 0.05）. The levels of serum matrix metalloproteinase-2 （MMP-2）， myeloperoxidase （MPO）， and semaphorin 3E （Sema3E） in the poor prognosis group were higher than those in the good prognosis group （P < 0.05）. High levels of serum MMP-2， MPO， and Sema3E were independent risk factors for poor prognosis in patients undergoing intracranial aneurysm clipping surgery under general anesthesia （OR = 1.087， 2.807， 2.079， P < 0.05）. The areas under the curve （AUC） for predicting the prognosis of patients undergoing intracranial aneurysm clipping surgery under general anesthesia using serum MMP-2， MPO， Sema3E， and combined detection were 0.747， 0.690， 0.656， and 0.809， respectively. The diagnostic sensitivities were 72.41%， 62.07%， 68.97%， and 86.21%， and the specificities were 72.92%， 73.96%， 66.67%， and 70.83%， respectively. Among them， the AUC of combined detection was the highest （P < 0.05）. The levels of serum MMP-2， MPO， and Sema3E in Hunt-Hess grade Ⅲ patients were higher than those in grade Ⅰ and Ⅱ patients， with grade Ⅱ patients having higher levels than grade Ⅰ patients. Patients with preoperative GCS scores < 8 had higher levels of serum MMP-2， MPO， and Sema3E than those with scores ≥ 8 （P < 0.05）. Serum MMP-2， MPO， and Sema3E were positively correlated with Hunt-Hess grading （r = 0.497， 0.662， 0.595， 0.639， P < 0.05） and negatively correlated with scores of preoperative GCS （r = -0.547， -0.602， -0.697， -0.521， P < 0.05）. Conclusions There was a certain correlation between Hunt-Hess grading， preoperative Glasgow Coma Scale （GCS） score， and the prognosis of patients undergoing intracranial aneurysm clipping surgery under general anesthesia. The levels of serum matrix metalloproteinase-2 （MMP-2）， myeloperoxidase （MPO）， and semaphorin 3E （Sema3E） were closely related to Hunt-Hess grading and GCS score. High levels of serum MMP-2， MPO， and Sema3E were independent risk factors for poor prognosis in patients undergoing intracranial aneurysm clipping surgery under general anesthesia and had high predictive value for patient prognosis. Among them， combined detection had the highest predictive value.

Key words: general anesthesia for intracranial aneurysm clipping surgery, matrix metalloproteinase 2, myeloperoxidase, neuroaxonal guidance factor 3E, prognosis, predictive value