Changes of serum MMP-9, NSE, MPO levels and prognostic influencing factors in patients with intracranial aneurysm undergoing interventional embolization at different treatment timing
Prognostic factors in aneurysm embolization
Abstract
Background: To analyzse the changes in serum levels of matrix metalloproteinase-9 (MMP-9), neuroenolase (NSE), myeloperoxidase (MPO) and prognostic factors in patients with intracranial aneurysm (IA) undergoing interventional embolization at different treatment times.
Methods: A retrospective analysis was made of 200 IA patients admitted to our department from January 2018 to June 2021 was performed. All patients underwent interventional embolization. According to the timing of surgery, the patients were divided into an early group (n=120, onset to surgery ≤72 h) and a delayed group (n=80, onset to surgery >72 h). The effect of embolization, complications and neurological deficit scale (NDS) scores were compared between the two groups. Serum MMP-9, NSE and MPO levels were compared before and after surgery, and the prognosis of all patients within 2 years after surgery was assessed by the Glasgow outcome scale (GOS) and divided accordingly into the good prognosis group (n=147) and the poor prognosis group (n=53) accordingly, and the prognostic factors influencing the patients were analysed univariately and multifactorially.
Results: After surgery, the rate of complete embolismwas higher in the early group than in the delayed group (P<0.05). After surgery, there was no statistical significance in the comparison of the individual complication rates in both groups (P>0.05). At 3d, 1 month, and 6 months after surgery, the NDS scores of patients in both groups were lower than those before surgery, and the within-group comparison of the NDS scores of patients in both groups at different time points was statistically significant (P<0.05). After surgery, serum MMP-9, NSE, and MPO levels were lower in both groups than before surgery, and they were lower in the early group than in the delayed group (P<0.05). GOS results showed that within 2 years after surgery, there were 97 and 23 cases with good and poor prognosis in the early group and 54 and 26 cases with good and poor prognosis in the delayed group, respectively, and the good prognosis rate in the early group was higher than that in the delayed group (P<0.05). Multifactorial analysis showed that delayed surgery, aneurysm in the posterior circulation, aneurysm neck width >4.5 mm, Fisher grade III-IV, Hunt-Hess grade III-IV, and hypertension were all independent risk factors for poor prognosis after IA interventional embolization (P<0.05).
Conclusion: Early interventional embolization in IA patients can improve their complete embolization rate and reduce serum MMP-9, NSE, and MPO levels; delayed surgery, aneurysm in the posterior circulation, aneurysm neck width >4.5 mm, Fisher grade III-IV, Hunt-Hess grade III-IV, and hypertension are strongly associated with poor prognosis after interventional embolization in IA patients.
References
1. Dietrich P. [Influence of genetics in intracranial aneurysms]. Radiologe 2020; 60(4): 329-33.
2. Tang H, Wang Q, Xu F, Zhang X, Zeng Z, Yan Y, et al. Underlying mechanism of hemodynamics and intracranial aneurysm. Chin Neurosurg J 2021; 7(1): 44.
3. Wen D, Wang X, Chen R, Li H, Zheng J, Fu W, et al. Single-Cell RNA Sequencing Reveals the Pathogenic Relevance of Intracranial Atherosclerosis in Blood Blister-Like Aneurysms. Front Immunol 2022; 13: 927125.
4. Signorelli F, Sela S, Gesualdo L, Chevrel S, Tollet F, Pailler-Mattei C, et al. Hemodynamic Stress, Inflammation, and Intracranial Aneurysm Development and Rupture: A Systematic Review. World Neurosurg 2018; 115: 234-44.
5. Leao DJ, Agarwal A, Mohan S, Bathla G. Intracranial vessel wall imaging: applications, interpretation, and pitfalls. Clin Radiol 2020; 75(10): 730-9.
6. Rinkel GJ, Ruigrok YM. Preventive screening for intracranial aneurysms. Int J Stroke 2022; 17(1): 30-6.
7. Sonig A, Shallwani H, Natarajan SK, Shakir HJ, Hopkins LN, Snyder KV, et al. Better Outcomes and Reduced Hospitalization Cost are Associated with Ultra-Early Treatment of Ruptured Intracranial Aneurysms: A US Nationwide Data Sample Study. Neurosurgery 2018; 82(4): 497-505.
8. Stephan S, Blanc R, Zmuda M, Vignal C, Barral M, Pistocchi S, et al. Endovascular treatment of carotid-cavernous fistulae: Long-term efficacy and prognostic factors. J Fr Ophtalmol 2016; 39(1): 74-81.
9. Johnson AK, Munich SA, Tan LA, Heiferman DM, Keigher KM, Lopes DK. Complication analysis in nitinol stent-assisted embolization of 486 intracranial aneurysms. J Neurosurg 2015; 123(2): 453-9.
10. Wang W, Guo Z, Xie D, Lin Z, Lin R. Relationship between MMP-9 Gene Polymorphism and Intracranial Aneurysm. Cell Mol Biol 2022; 68(1):
11. Zheng D, Zhao S, Zhang N, Shi J. Brain protective effect and hemodynamics of dexmedetomidine hydrochloride in patients with intracranial aneurysm. Saudi J Biol Sci 2020; 27(7): 1850-5.
12. Zhang Z, Sui R, Ge L, Xia D. CircRNA_0079586 and circRNA_RanGAP1 are involved in the pathogenesis of intracranial aneurysms rupture by regulating the expression of MPO. Sci Rep-Uk 2021; 11(1): 19800.
13. Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis 2013; 35(2): 93-112.
14. Neurointerventional Group of the Chinese Medical Association Neurosurgery Branch. Chinese expert consensus on endovascular intervention for intracranial aneurysms (2013). Chinese Medical Journal 2013; 93(39): 3093-3103.
15. Dorsch N. A clinical review of cerebral vasospasm and delayed ischaemia following aneurysm rupture. Acta Neurochir Suppl 2011; 110(Pt 1): 5-6.
16. Li H, Gao BL, Li CH, Wang JW, Liu JF, Yang ST. Endovascular Retreatment of Cerebral Aneurysms Previously Treated with Endovascular Embolization. J Neurol Surg Part a 2020; 81(3): 207-12.
17. Jiang C, Luan D, Wang C, Liu Q, Han J, Li G. Risk and Prognostic Factors for Rupture of Intracranial Aneurysms During Endovascular Embolization. World Neurosurg 2019; 129(e641-9.
18. Zou L, Hou Y, Yu B, Li S, Du Y. The effect of intravascular interventional embolization and craniotomy on MMP-2, MMP-9 and caspase3 in serum of intracranial aneurysm patients. Exp Ther Med 2018; 16(6): 4511-8.
19. El SM, El-Raggal NM, El-Farrash RA, Shaaban HA, Mohamed HE, Barakat NM, et al. Cerebral blood flow and serum neuron-specific enolase in early-onset neonatal sepsis. Pediatr Res 2018; 84(2): 261-6.
20. Ridwan S, Urbach H, Greschus S, Hagen JV, Esche J, Bostrom A. Health Economic Aspects of Aneurysmal Subarachnoid Hemorrhage: Factors Determining First Year In-Hospital Treatment Expenses. J Neurol Surg Part a 2021; 82(3): 204-10.
21. Mahta A, Murray K, Reznik ME, Thompson BB, Wendell LC, Furie KL. Early Neurological Changes and Interpretation of Clinical Grades in Aneurysmal Subarachnoid Hemorrhage. J Stroke Cerebrovasc 2021; 30(9): 105939.
22. Gutierrez J, Turan TN, Hoh BL, Chimowitz MI. Intracranial atherosclerotic stenosis: risk factors, diagnosis, and treatment. Lancet Neurol 2022; 21(4): 355-68.
Copyright (c) 2023 Chunmiao Wu, Xingyu Dong, Qiang Li, Shengming Liu, Yuhao He, Yang Zhang, Sunfu Zhang
This work is licensed under a Creative Commons Attribution 4.0 International License.
The published articles will be distributed under the Creative Commons Attribution 4.0 International License (CC BY). It is allowed to copy and redistribute the material in any medium or format, and remix, transform, and build upon it for any purpose, even commercially, as long as appropriate credit is given to the original author(s), a link to the license is provided and it is indicated if changes were made. Users are required to provide full bibliographic description of the original publication (authors, article title, journal title, volume, issue, pages), as well as its DOI code. In electronic publishing, users are also required to link the content with both the original article published in Journal of Medical Biochemistry and the licence used.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.