血清基质金属蛋白酶2、髓过氧化物酶、神经轴突导向因子3E对全麻颅内动脉瘤夹闭术患者预后的预测价值

doi:10.3969/j.issn.1006-5725.2026.01.007

Abstract

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

CLC Number:

R739.41

Xinghua BIAN,Peng XU,Junfei SHI,Zhenhua MA. The predictive value of serum matrix metalloproteinase-2， myeloperoxidase， axonal guidance factor 3E for the prognosis of patients undergoing intracranial aneurysm clipping surgery under general anesthesia[J]. The Journal of Practical Medicine, 2026, 42(1): 56-63.

Figures/Tables 11

Tab.1

Comparison of clinical data between two groups"

因素	预后不良组（n = 29）	预后良好组（n = 96）	Z/χ² /t值	P值
性别			0.287	0.592
男	20（68.97）	61（63.54）
女	9（31.03）	35（36.46）
年龄（x ± s）/岁	60.43 ± 10.54	58.92 ± 9.75	0.717	0.475
BMI（x ± s）/（kg/m²）	23.43 ± 1.12	23.35 ± 1.09	0.344	0.731
高血压史			0.266	0.606
有	8（27.59）	22（22.92）
无	21（72.41）	74（77.08）
糖尿病			2.905	0.088
有	7（24.14）	11（11.46）
无	22（75.86）	85（88.54）
冠心病			1.212	0.271
有	6（20.69）	12（12.50）
无	23（79.31）	84（87.50）
吸烟史			0.132	0.717
有	6（20.69）	17（17.71）
无	23（79.31）	79（82.29）
饮酒史			0.054	0.816
有	6（20.69）	18（18.75）
无	23（79.31）	78（81.25）
瘤颈形态			1.160	0.281
宽颈	21（72.41）	59（61.46）
窄颈	8（27.59）	37（38.54）
动脉瘤直径（ $x ˉ ± s$ ）/mm	5.21 ± 1.32	5.18 ± 1.23	0.113	0.910
动脉瘤部位			0.066	0.948
前交通动脉	2（6.90）	8（8.33）
后交通动脉	3（10.34）	13（13.54）
大脑前动脉	8（27.59）	22（22.92）
大脑中动脉	7（24.14）	21（21.88）
大脑后动脉	5（17.24）	18（18.75）
椎基底动脉	4（13.79）	14（14.58）
有无子囊			0.003	0.957
有	8（27.59）	26（27.08）
无	21（72.41）	70（72.92）
Hunt-Hess分级			2.210	0.027
Ⅰ级	10（34.48）	51（53.13）
Ⅱ级	11（37.93）	35（36.46）
Ⅲ级	8（27.59）	10（10.42）
术前GCS评分			35.856	< 0.001
< 8分	15（51.72）	5（5.21）
≥ 8分	14（48.28）	91（94.79）

Tab.1

Tab.2

Tab.3

Tab.4

Fig.1

Tab.5

Tab.6

Fig.2

Fig.3

Fig.4

Fig.5

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指标	预后不良组（n = 29）	预后良好组（n = 96）	t值	P值
MMP-2/（ng/L）	16.32 ± 4.17	10.54 ± 3.65	7.226	< 0.001
MPO/（ng/mL）	46.32 ± 6.32	35.65 ± 3.82	11.159	< 0.001
Sema3E/（μg/L）	7.02 ± 1.32	3.98 ± 0.99	13.357	< 0.001

变量	β	SE	Waldχ²	P值	OR	95%CI
Hunt-Hess分级Ⅲ级	0.343	0.402	0.728	0.394	1.409	0.641 ~ 3.099
术前GCS评分< 8分	0.732	0.637	1.321	0.250	2.079	0.597 ~ 7.247
血清MMP-2水平高	0.083	0.012	47.840	< 0.001	1.087	1.061 ~ 1.112
血清MPO水平高	1.032	0.439	5.526	0.019	2.807	1.187 ~ 6.636
血清Sema3E水平高	0.732	0.314	5.435	0.020	2.079	1.124 ~ 3.848

临床特征	例数	MMP-2/（ng/L）	MPO/（ng/mL）	Sema3E/（μg/L）
Hunt-Hess分级
Ⅰ级	61	9.54 ± 2.95	33.43 ± 3.32	3.39 ± 0.84
Ⅱ级	46	12.77 ± 4.21^d	40.43 ± 5.32^d	5.43 ± 1.18^d
Ⅲ级	18	17.54 ± 5.43^de	48.15 ± 5.71^de	7.17 ± 1.54^de
术前GCS评分
< 8分	20	18.40 ± 5.19^f	49.86 ± 4.82^f	6.34 ± 1.36^f
≥ 8分	105	10.64 ± 3.50	35.89 ± 4.32	4.37 ± 1.01

The predictive value of serum matrix metalloproteinase-2， myeloperoxidase， axonal guidance factor 3E for the prognosis of patients undergoing intracranial aneurysm clipping surgery under general anesthesia

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指标	截断值	AUC	敏感度/%	特异度/%	P值	95%CI
MMP-2/（ng/L）	12.20	0.747	72.41	72.92	< 0.001	0.662 ~ 0.821
MPO/（ng/mL）	36.35	0.690	62.07	73.96	< 0.001	0.601 ~ 0.770
Sema3E/（μg/L）	5.33	0.656	68.97	66.67	< 0.001	0.566 ~ 0.739
联合检测		0.809	86.21	70.83	< 0.001	0.729 ~ 0.873

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指标	Hunt-Hess分级		术前GCS评分
指标	r	P值	r	P值
MMP-2	0.497	0.023	-0.547	0.016
MPO	0.662	0.004	-0.602	0.011
Sema3E	0.595	0.013	-0.697	0.001