重症颅脑损伤减压术患者血清MMP-10、TLR2水平及其与疾病转归的关系

doi:10.11958/20242355

天津医药 ›› 2025, Vol. 53 ›› Issue (7): 704-708.doi: 10.11958/20242355

重症颅脑损伤减压术患者血清MMP-10、TLR2水平及其与疾病转归的关系

吴素勤(), 徐子舒, 许智晶, 吴洁, 王聪梅^△()

河南省直第三人民医院重症医学科（邮编450018）

收稿日期:2024-12-25 修回日期:2025-04-07 出版日期:2025-07-15 发布日期:2025-07-21
通讯作者: ^△E-mail：676485154@qq.com
作者简介:吴素勤（1987），女，主管护师，主要从事重症医学方面研究。E-mail：limei178843@163.com
基金资助:
河南省医学科学院青年医学科研人员研究项目(QNYJ2023011)

Serum levels of MMP-10 and TLR2 in patients with severe traumatic brain injury underwent decompression surgery and their relationship with disease prognosis

WU Suqin(), XU Zishu, XU Zhijing, WU Jie, WANG Congmei^△()

Department of Intensive Care Medicine, the Third People's Hospital of Henan Province, Zhengzhou 450018, China

Received:2024-12-25 Revised:2025-04-07 Published:2025-07-15 Online:2025-07-21
Contact: ^△E-mail：676485154@qq.com

吴素勤, 徐子舒, 许智晶, 吴洁, 王聪梅. 重症颅脑损伤减压术患者血清MMP-10、TLR2水平及其与疾病转归的关系[J]. 天津医药, 2025, 53(7): 704-708.

WU Suqin, XU Zishu, XU Zhijing, WU Jie, WANG Congmei. Serum levels of MMP-10 and TLR2 in patients with severe traumatic brain injury underwent decompression surgery and their relationship with disease prognosis[J]. Tianjin Medical Journal, 2025, 53(7): 704-708.

摘要/Abstract

摘要：

目的分析重症颅脑损伤（sTBI）减压术（DC）患者血清中基质金属蛋白酶-10（MMP-10）、Toll样受体2（TLR2）的表达水平，并探讨二者与疾病转归的关系。方法纳入单中心接受DC治疗的sTBI患者94例为观察组。另选取同期在该中心体检的健康志愿者90例为对照组。收集各组资料并比较其差异，酶联免疫吸附试验（ELISA）检测血清MMP-10、TLR2的水平。术后6个月，将sTBI患者按照格拉斯哥预后评分（GOS）分为良好组（n=53）和不良组（n=41）。Spearman法分析MMP-10、TLR2水平与疾病转归之间的相关性；Logistic回归模型分析sTBI患者DC后疾病转归情况的影响因素；受试者工作特征（ROC）曲线评估血清MMP-10、TLR2水平对sTBI患者DC后疾病转归情况的预测价值。结果与对照组相比，观察组患者血清MMP-10、TLR2表达水平显著升高（P<0.01）。与良好组相比，不良组合并脑疝、出现多发脑挫裂伤的比例和血清MMP-10、TLR2水平显著升高，格拉斯哥昏迷量表（GCS）评分则显著降低（P<0.05）。sTBI患者血清MMP-10、TLR2水平均与DC后疾病预后不良呈正相关（P<0.05）；血清MMP-10、TLR2水平升高，合并脑疝和发生多发脑挫裂伤是影响sTBI患者DC后疾病预后不良的危险因素，GCS评分升高则为保护因素（P<0.05）；血清MMP-10、TLR2单独及联合预测sTBI患者DC后疾病转归情况的曲线下面积（AUC）分别为0.839（95%CI：0.749~0.907）、0.847（95%CI：0.758~0.913）、0.925（95%CI：0.852~0.969），联合检测优于二者单独检测（均P<0.05）。结论 sTBI患者血清MMP-10、TLR2表达水平均显著升高，二者与DC后疾病转归情况显著相关。

关键词: 颅脑损伤, 危重病, 脑水肿, 减压颅骨切除术, 基质金属蛋白酶10, Toll样受体2, 预后

Abstract:

Objective To analyze the expression levels of matrix metalloproteinase-10 (MMP-10) and Toll-like receptor 2 (TLR2) in serum of patients underwent decompression surgery (DC) for severe traumatic brain injury (sTBI), and to explore their relationship with disease outcome. Methods From April 2021 to April 2024, sTBI patients (n=94) who received DC treatment in a single center were collected as the observation group. Another 90 healthy volunteers who underwent physical examinations at our hospital were selected as the control group. Six months after surgery, sTBI patients were assigned into the good group (n=53) and the adverse group (n=41) according to the Glasgow Outcome Scale (GOS). Data was collected from each group and their differences were compared. Enzyme linked immunosorbent assay (ELISA) was used to measure serum levels of MMP-10 and TLR2. Spearman method was used to analyze the correlation between MMP-10, TLR2 levels and disease outcomes. Logistic regression model used to analyze influencing factors of disease outcomes in sTBI patients after DC. The receiver operating characteristic (ROC) curve was applied to evaluate the predictive value of serum MMP-10 and TLR2 levels for disease outcome in sTBI patients after DC. Results Compared with the control group, the expression levels of serum MMP-10 and TLR2 were prominently higher in the observation group (P<0.05). Compared with the good group, the proportions of sTBI patients with cerebral herniation, multiple brain contusions and lacerations, and serum levels of MMP-10 and TLR2 were significantly higher in the adverse group, while Glasgow Coma Scale (GCS) score was significantly lower (P<0.05). Serum levels of MMP-10 and TLR2 in sTBI patients were positively correlated with poor prognosis after DC (P<0.05). Elevated levels of serum MMP-10 and TLR2, and the increased proportions of patients with cerebral herniation and multiple brain contusions were risk factors affecting the disease outcome after DC in sTBI patients, while elevated GCS score was a protective factor (P<0.05). The area under the curve (AUC) for predicting disease outcome in sTBI patients after DC using serum MMP-10 and TLR2 alone and in combination was 0.839 (95%CI: 0.749-0.907), 0.847 (95%CI: 0.758-0.913) and 0.925 (95%CI: 0.852-0.969), respectively. The combined detection was superior to the individual detections (Z_{combination -MMP-10}=2.199, Z_{combination - TLR2}=2.377, both P<0.05). Conclusion The expression levels of serum MMP-10 and TLR2 in sTBI patients are significantly elevated, and both are prominently correlated with disease outcome after DC.

Key words: craniocerebral trauma, critical illness, brain edema, decompressive craniectomy, matrix metalloproteinase 10, Toll-like receptor 2, prognosis

中图分类号:

R651.11

图/表 5

参考文献 23

[1]	王建海, 白应斌. 标准外伤大骨瓣开颅手术治疗颅脑损伤合并恶性颅内高压临床研究[J]. 山西医药杂志, 2020, 49(14):1863-1865.
	WANG J H, BAI Y B. Clinical study of standard traumatic large bone flap craniotomy in the treatment of craniocerebral injury with malignant intracranial hypertension[J]. Shanxi Journal of Medicine, 2020, 49(14):1863-1865. doi:10.3969/j.issn.0253-9926.2020.14.033.
[2]	WANG H, HE Y, LIANG R, et al. A meta-analysis and systematic review of intracranial pressure monitoring on severe craniocerebral injury[J]. Ann Palliat Med, 2021, 10(5):5380-5390. doi:10.21037/apm-21-897.
[3]	王黎, 尹凯, 高红欣. 脑脊液循环重建联合大骨瓣开颅减压术对重型颅脑损伤患者血清HIF-1α、GFAP及t-PA水平的影响[J]. 中国医学工程, 2021, 29(8):120-122.
	WANG L, YIN K, GAO H X. Effect of cerebrospinal fluid circulation reconstruction combined with large bone flap craniotomy on the levels of serum HIF-1α,GFAP and t-PA in patients with severe craniocerebral injury[J]. Chinese Medical Engineering, 2021, 29(8):120-122. doi:10.19338/j.issn.1672-2019.2021.08.034.
[4]	CHI P L, CHENG C C, HUNG C C, et al. MMP-10 from M1 macrophages promotes pulmonary vascular remodeling and pulmonary arterial hypertension[J]. Int J Biol Sci, 2022, 18(1):331-348. doi:10.7150/ijbs.66472.
[5]	WU L N, WANG W F, WANG X W, et al. MMP-10 rs17435959 polymorphism is associated with the formation and stability of carotid atherosclerosis plaque: a case-control study[J]. J Stroke Cerebrovasc Dis, 2021, 30(10):106045. doi:10.1016/j.jstrokecerebrovasdis.2021.106045.
[6]	LI W, YU Y, LI D, et al. TLR2 deficiency attenuated chronic intermittent hypoxia-induced neurocognitive deficits[J]. Int Immunopharmacol, 2020,81:106284. doi:10.1016/j.intimp.2020.106284.
[7]	MIYATA S. Glial functions in the blood-brain communication at the circumventricular organs[J]. Front Neurosci, 2022,16:991779. doi:10.3389/fnins.2022.991779.
[8]	焦保华, 赵宗茂. 《第4版美国重型颅脑损伤诊疗指南》解读[J]. 河北医科大学学报, 2018, 39(2):125-145.
	JIAO B H, ZHAO Z M. Interpretation of the fourth edition of the American guidelines for the diagnosis and treatment of severe traumatic brain injury[J]. Journal of Hebei Medical University, 2018, 39(2):125-145. doi:10.3969/j.issn.1007-3205.2018.02.001.
[9]	顾永, 任艳明, 杨朝华, 等. 去骨瓣减压术在重型颅脑损伤中的应用进展[J]. 西部医学, 2022, 34(6):932-936.
	GU Y, REN Y M, YANG C H, et al. Application progress of decompressive craniectomy in severe craniocerebral injury[J]. Western Medicine, 2022, 34(6):932-936. doi:10.3969/j.issn.1672-3511.2022.06.031.
[10]	ABACIOGLU O O, KOYUNSEVER N Y, KILIC S, et al. Glasgow prognostic score as a marker of mortality after TAVI[J]. Braz J Cardiovasc Surg, 2021, 36(6):796-801. doi:10.21470/1678-9741-2020-0269.
[11]	YUAN L, HUANG Y, CHENG Y. Correlation between the degree of inflammation and stress indicators and concurrent cognitive impairment in patients with severe craniocerebral injury[J]. Actas Esp Psiquiatr, 2024, 52(3):317-324. doi:10.62641/aep.v52i3.1657.
[12]	WANG Y, HUANG C, TIAN R, et al. Target temperature management and therapeutic hypothermia in sever neuroprotection for traumatic brain injury:clinic value and effect on oxidative stress[J]. Medicine(Baltimore), 2023, 102(10):e32921. doi:10.1097/MD.0000000000032921.
[13]	ZHANG H Y, TIAN Y, SHI H Y, et al. The critical role of the endolysosomal system in cerebral ischemia[J]. Neural Regen Res, 2023, 18(5):983-990. doi:10.4103/1673-5374.355745.
[14]	HAWRYLUK G, RUBIANO A M, TOTTEN A M, et al. Guidelines for the management of severe traumatic brain injury:2020 update of the decompressive craniectomy recommendations[J]. Neurosurgery, 2020, 87(3):427-434. doi:10.1093/neuros/nyaa278.
[15]	刘龙, 王德辉. 重型颅脑损伤标准去骨瓣减压术后30 d内死亡的危险因素分析[J]. 中国临床神经外科杂志, 2021, 26(2):92-94.
	LIU L, WANG D H. Risk factors of death within 30 days after standard decompressive craniectomy for severe craniocerebral injury[J]. Chin J Clin Neurosurg, 2021, 26(2):92-94. doi:10.13798/j.issn.1009-153X.2021.02.009.
[16]	BASSIOUNI W, ALI M, SCHULZ R. Multifunctional intracellular matrix metalloproteinases: implications in disease[J]. FEBS J, 2021, 288(24):7162-7182. doi:10.1111/febs.15701.
[17]	曲明卫, 王立敏, 朱兰, 等. 血清NSE、MMP-10、s100β与急性脑梗死患者神经功能缺损程度的关系研究[J]. 神经损伤与功能重建, 2020, 15(7):408-409.
	QU M W, WANG L M, ZHU L, et al. The relationship between serum NSE, MMP-10, s100β and the degree of neurological deficit in patients with acute cerebral infarction[J]. Nerve injury and Functional Reconstruction, 2020, 15(7):408-409. doi:10.16780/j.cnki.sjssgncj.20191157.
[18]	李冬璇, 韩秋菊, 张建. TLR2免疫调节作用的研究进展[J]. 现代免疫学, 2022, 42(1):82-85.
	LI D X, HAN Q J, ZHANG J. Research progress on the immunomodulatory effect of TLR2[J]. Modern Immunology, 2022, 42(1):82-85. doi:1001-2478(2022)01-0082-04.
[19]	ZHU X, CHENG J, YU J, et al. Nicotinamide mononucleotides alleviated neurological impairment via anti-neuroinflammation in traumatic brain injury[J]. Int J Med Sci, 2023, 20(3):307-317. doi:10.7150/ijms.80942.
[20]	张旭阳, 王新军, 付旭东, 等. 轻型颅脑损伤伴轻度认知功能障碍患者血清HMGB1和TLR2及TLR4水平及其临床意义研究[J]. 中国全科医学, 2019, 22(6):673-677.
	ZHANG X Y, WANG X J, FU X D, et al. Serum levels of HMGB1, TLR2 and TLR4 in patients with mild traumatic brain injury and mild cognitive impairment and their clinical significance[J]. Chin J General Med, 2019, 22(6):673-677. doi:10.12114/j.issn.1007-9572.2018.00.242.
[21]	黄蔚文, 赵岳峰. 重型颅脑损伤患者外周血miR-122-5p表达水平变化及其对近期预后的预测价值[J]. 卒中与神经疾病, 2021, 28(1):88-91.
	HUANG W W, ZHAO Y F. Expression of miR-122-5p in peripheral blood of patients with severe craniocerebral injury and its predictive value for short-term prognosis[J]. Stroke and Neurological Diseases, 2021, 28(1):88-91. doi:10.3969/j.issn.1007-0478.2021.01.018.
[22]	陈剑, 鲍得俊, 张环, 等. 严重颅脑损伤预后不良相关预告因素探讨[J]. 安徽医科大学学报, 2019, 54(8):1277-1281.
	CHEN J, BAO D J, ZHANG H, et al. Predictive factors for poor prognosis of severe craniocerebral injury[J]. Journal of Anhui Medical University, 2019, 54(8):1277-1281. doi:10.19405/j.cnki.issn1000-1492.2019.08.022.
[23]	陈华辉, 张刚利, 张豪, 等. 急性颅脑损伤患者早期预后相关因素分析[J]. 山西医科大学学报, 2019, 50(1):112-116.
	CHEN H H, ZHANG G L, ZHANG H, et al. Related factors of early prognosis in patients with acute craniocerebral injury[J]. Journal of Shanxi Medical University, 2019, 50(1):112-116. doi:10.13753/j.issn.1007-6611.2019.01.022.

组别	n	MMP-10	TLR2
对照组	90	3.37±1.19	0.58±0.15
观察组	94	6.41±1.66	2.04±0.47
t		14.417^＊＊	28.903^＊＊

组别	n	MMP-10	TLR2
对照组	90	3.37±1.19	0.58±0.15
观察组	94	6.41±1.66	2.04±0.47
t		14.417^＊＊	28.903^＊＊

组别		n		性别（男/女）			年龄/岁				BMI/（kg/m²）				病因^a
良好组		53		31/22			58.32±8.69				23.12±4.19				13/32/8
不良组		41		22/19			61.17±7.75				23.59±4.41				10/24/7
t或χ²				0.219			1.652				0.526				0.070
组别		并发症			合并脑疝				多发脑挫裂伤				Hb/（g/L）
良好组		29（54.72）			24（45.28）				19（35.85）				112.78±24.13
不良组		23（56.10）			27（65.85）				24（58.54）				109.24±26.95
t或χ²		0.018			3.941^＊				4.794^＊				0.670
组别	GCS评分/分					WBC/（×10⁹/L）				PLT/（×10⁹/L）				CRP/（mg/L）
良好组	5.26±1.58					111.92±21.87				176.37±34.79				20.62±5.59
不良组	4.09±1.06					109.24±26.95				184.28±39.16				23.15±7.46
t	4.286^＊＊					0.532				1.034				1.889
组别			FBG/（mmol/L）					MMP-10/（μg/L）				TLR2/（μg/L）
良好组			8.29±1.76					5.63±0.93				1.62±0.58
不良组			9.11±2.32					7.42±1.71				2.59±0.77
t			1.958					6.099^＊＊				6.772^＊＊

组别		n		性别（男/女）			年龄/岁				BMI/（kg/m²）				病因^a
良好组		53		31/22			58.32±8.69				23.12±4.19				13/32/8
不良组		41		22/19			61.17±7.75				23.59±4.41				10/24/7
t或χ²				0.219			1.652				0.526				0.070
组别		并发症			合并脑疝				多发脑挫裂伤				Hb/（g/L）
良好组		29（54.72）			24（45.28）				19（35.85）				112.78±24.13
不良组		23（56.10）			27（65.85）				24（58.54）				109.24±26.95
t或χ²		0.018			3.941^＊				4.794^＊				0.670
组别	GCS评分/分					WBC/（×10⁹/L）				PLT/（×10⁹/L）				CRP/（mg/L）
良好组	5.26±1.58					111.92±21.87				176.37±34.79				20.62±5.59
不良组	4.09±1.06					109.24±26.95				184.28±39.16				23.15±7.46
t	4.286^＊＊					0.532				1.034				1.889
组别			FBG/（mmol/L）					MMP-10/（μg/L）				TLR2/（μg/L）
良好组			8.29±1.76					5.63±0.93				1.62±0.58
不良组			9.11±2.32					7.42±1.71				2.59±0.77
t			1.958					6.099^＊＊				6.772^＊＊

变量	β	SE	Wald χ²	P	OR	OR 95%CI
MMP-10	0.654	0.183	12.788	<0.001	1.924	1.344~2.754
TLR2	0.758	0.271	7.833	0.005	2.135	1.255~3.631
GCS评分	-0.178	0.064	7.729	0.005	0.837	0.738~0.949
合并脑疝	0.332	0.126	6.950	0.008	1.394	1.089~1.784
多发脑挫裂伤	0.290	0.105	7.611	0.006	1.336	1.087~1.641
常数项	0.218	0.197	1.825	0.184	1.307

重症颅脑损伤减压术患者血清MMP-10、TLR2水平及其与疾病转归的关系

Serum levels of MMP-10 and TLR2 in patients with severe traumatic brain injury underwent decompression surgery and their relationship with disease prognosis

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指标	AUC	95%CI	敏感度/ %	特异度/ %	约登指数	截断值/ （μg/L）
MMP-10	0.839	0.749~0.907	65.85	92.45	0.583	7.02
TLR2	0.847	0.758~0.913	78.05	79.25	0.573	2.07
联合检测	0.925	0.852~0.969	73.17	98.11	0.713	-

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