目的 探讨血清基质金属蛋白酶2（MMP-2）、髓过氧化物酶（MPO）、神经轴突导向因子3E（Sema3E）对全麻颅内动脉瘤夹闭术患者预后的预测价值。 方法 选取2023年5月至2025年5月张家口市第一医院收治125例全麻颅内动脉瘤夹闭术患者作为研究对象，根据术后1个月格拉斯哥预后评分（GOS），将1 ~ 3分的患者纳入预后不良组（29例），4 ~ 5分的患者纳入预后良好组（96例）。比较两组临床资料及血清MMP-2、MPO、Sema3E水平，并予以多因素logistic回归分析法分析全麻颅内动脉瘤夹闭术患者预后不良的危险因素，采用受试者工作特征（ROC）曲线分析血清MMP-2、MPO、Sema3E对全麻颅内动脉瘤夹闭术患者预后的预测价值，比较不同临床特征血清MMP-2、MPO、Sema3E水平，采用Spearman相关性分析血清MMP-2、MPO、Sema3E与临床特征的相关性。 结果 预后不良组Hunt-Hess分级Ⅲ级、术前GCS评分< 8分的患者占比为27.59%、51.72%，高于预后良好组的10.42%、5.21%（P < 0.05）。预后不良组血清MMP-2、MPO、Sema3E水平均高于预后良好组（P < 0.05）。血清MMP-2、MPO、Sema3E水平高是全麻颅内动脉瘤夹闭术患者预后不良的独立危险因素（OR = 1.087、2.807、2.079，P < 0.05）。血清MMP-2、MPO、Sema3E及联合检测预测全麻颅内动脉瘤夹闭术患者预后的曲线下面积（AUC）分别为0.747、0.690、0.656、0.809，诊断敏感度分别为72.41%、62.07%、68.97%、86.21%，特异度分别为72.92%、73.96%、66.67%、70.83%，其中联合检测的AUC最高（P < 0.05）。Hunt-Hess分级Ⅲ级患者血清MMP-2、MPO、Sema3E水平高于Ⅰ级、Ⅱ级患者，Ⅱ级患者高于Ⅰ级患者；术前GCS评分< 8分的患者血清MMP-2、MPO、Sema3E水平高于≥ 8分的患者（P < 0.05）。血清MMP-2、MPO、Sema3E与Hunt-Hess分级均呈正相关（r= 0.497、0.662、0.595，P < 0.05），与术前GCS评分均呈正相关（r = -0.547、-0.602、-0.697，P < 0.05）。 结论 全麻颅内动脉瘤夹闭术患者Hunt-Hess分级及术前GCS评分与预后具有一定联系，且血清MMP-2、MPO、Sema3E水平与Hunt-Hess分级、GCS评分密切相关，血清MMP-2、MPO、Sema3E水平高均为全麻颅内动脉瘤夹闭术患者预后不良的独立危险因素，且对患者预后具有较高预测价值，其中联合检测的预测价值最高。

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.