基于血液的MMP-9对急性缺血性卒中早期鉴别的系统回顾和荟萃分析

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-09-22 DOI:10.1016/j.jstrokecerebrovasdis.2025.108454

Jan Emmerich , Aditya Chanpura , Tyler Lu , Alison Baird , Frank Barone , Deborah Gustafson , Timo Siepmann , Hagen Huttner , Kristian Barlinn

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引用次数: 0

摘要

背景：急性缺血性卒中（AIS）和卒中模拟的早期鉴别在急诊环境中仍然具有挑战性。分子生物标志物如基质金属蛋白酶-9 （MMP-9）可能有助于提高诊断的准确性。方法：根据PRISMA指南在PubMed、EMBASE、Cochrane Library和Web of Science中进行系统的文献检索。评估AIS患者与卒中模拟患者或健康/匹配对照≥18岁患者症状发作24小时内MMP-9浓度的研究纳入其中。随机效应荟萃分析用于估计组间MMP-9水平的汇总平均差异（MD）。结果：纳入27项研究，其中16项（2661例AIS患者，1283例对照组）符合meta分析标准。与所有对照组相比，AIS患者的平均MMP-9浓度显著高于所有对照组（MD: 93.9 ng/mL; 95%CI: 25.0-162.8; p=0.01, I²=96%,Cochran’s Q: p）。结论：与卒中模拟患者和健康对照组/匹配对照组相比，AIS患者的MMP-9水平显着升高，支持其作为急性环境诊断生物标志物的潜力。然而，大量的研究间异质性限制了通用性，需要标准化研究来验证其临床适用性。（PROSPERO: CRD42024611953）资金支持：我们感谢德国研究基金会、卡尔·古斯塔夫·卡鲁斯医学院、德国社会科学院以及德累斯顿工业大学开放获取出版基金的支持。资助机构对研究的任何方面或手稿的内容都没有影响。

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Blood-based MMP-9 for the early differentiation of acute ischemic stroke: a systematic review and meta-analysis

Background

Early differentiation between acute ischemic stroke (AIS) and stroke mimics remains challenging in emergency setting. Molecular biomarkers such as matrix metalloproteinase-9 (MMP-9) may aid in improving diagnostic accuracy.

Methods

A systematic literature search was conducted according to PRISMA guidelines across PubMed, EMBASE, Cochrane Library, and Web of Science. Studies assessing MMP-9 concentrations within 24 hours of symptom onset in AIS patients versus stroke mimics or healthy/matched controls ≥18 years were included. Random-effects meta-analyses were used to estimate pooled mean differences (MD) in MMP-9 levels between groups. Heterogeneity was assessed using I² and Cochran’s Q.

Results

Twenty-seven studies were included, with 16 (2,661 AIS patients, 1,283 all controls) meeting criteria for meta-analysis. Mean MMP-9 concentrations were significantly higher in AIS patients compared to all controls combined (MD: 93.9 ng/mL; 95%CI: 25.0-162.8; p=0.01, I²=96%, Cochran's Q: p<0.001). Subgroup analyses confirmed elevated levels in AIS patients versus healthy/matched controls (MD: 110.6 ng/mL; 95%CI:13.8-207.4; p=0.029) and versus stroke mimics (MD: 66.61 ng/mL; 95%CI: -6.2-139.4; p=0.01). Heterogeneity remained consistently high across comparisons (I² ≥ 95%; p<0.05).

Conclusion

MMP-9 levels appear significantly elevated in AIS patients compared to both stroke mimics and healthy controls/matched controls, supporting its potential as a diagnostic biomarker in the acute setting. However, substantial inter-study heterogeneity limits generalizability, and standardized studies are needed to validate their clinical applicability. (PROSPERO: CRD42024611953)

Funding

We acknowledge support from the German Research Foundation, the Medical Faculty Carl Gustav Carus, and the SLUB, as well as the Open Access Publication Funds of the TU Dresden. The funding bodies had no impact on any aspect of the study or the content of the manuscript.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.