急性冠状动脉综合征患者支架植入术后再狭窄与基质金属蛋白酶相关性的研究  

The change of plasma matrix metalioproteinases and its effects on post-stenting restenosis in the patients with acute coronary syndrome

作　　者：许官学[1] 赵然尊[1] 石蓓[1] 

机构地区：[1]贵州省遵义医学院附属医院心内科 563003

出　　处：《中华老年医学杂志》2009年第10期808-811,共4页Chinese Journal of Geriatrics

基　　金：贵州省省长基金（C301）

摘　　要：目的测定急性冠状动脉综合征（ACS）支架植入术后再狭窄患者动脉血基质金属蛋白酶（MMP）-3、-9及其组织抑制剂TIMI-1水平变化，初步分析支架内再狭窄与基质金属蛋白酶水平之间可能存在的相关性。方法132例ACS患者，分别收集其冠状动脉内支架植入术前和术后即刻、8、48h和1周的股动脉血标本，采用酶联免疫吸附试验（ELISA）法检测MMP-3、MMP-9和TIMI1水平；随访5～10个月后行冠状动脉造影，根据造影结果分为再狭窄组21例，非再狭窄组Ⅲ例，均于造影术前股动脉采集动脉血标本重复指标测定。50例冠状动脉造影正常者为对照组。结果与对照组比较，ACS组动脉血MMP-3和MMP-9浓度明显升高[MMP-3：（15．99±4．30）ng／L与（4．86±2．98）ng／L，t=2．290，P=0．022；MMP-9：（1．414-3．06）ng／L与（3．79±1．46）ng／L，t=2．011，P=0．041]，T1MP-1浓度有升高趋势。支架植入术后MMP3和MMP-9水平均较术前明显升高，48h达到高峰，1周时仍明显升高，TIMP-1水平也具有类似的变化，但高峰时间延迟。再狭窄组术前MMP-9水平较非再狭窄组升高[（17．94±6．44）ng／L与（9．93±2．19）ng／L，t=3．180，P-0．003]，而两组间术前MMP3和TIMP-1水平差异无统计学意义；随访时再狭窄组MMP-3和MMP-9水平均较非再狭窄组明显升高[MMP-3：（21．66±2．72）ng／L与（14．27±1．28）ng／L，t=2．181，P=0．033；MMP9：（22．81±5．31）ng／L与（12．10±2．76）ng／L，t=2．108，P=0．039]，而TIMP-1水平差异无统计学意义。结论动脉血MMP-3和MMP-9水平升高可能参与了ACS患者支架置人术后的病理、生理过程，并可能与术后再狭窄的发生有一定相关性。Objective To investigate the change of matrix metalloproteinase 3（MMP-3）, matrix metalloproteinase 9（MMP-9） and tissue inhibitors of metalloproteinase 1 （TIMP 1） in arterial plasma and their effects on post stenting restenosis in the patients with acute coronary syndrome（ACS）. Methods MMP-3, MMP 9 and TIMP-1 in arterial plasma were detected by enzyme-linked imrnunosorbent assay （ELISA） in 132 patients with ACS. The 132 patients were divided into two groups： restenosis group（n=21） and non-restenosis group（n=l 11）, while 50 persons were as a normal control group. Results The levels of MMP 3[（15.99±4.30） vs. （4.86±2.98） ng/L, P= 0.022] and MMP 9[（1.41±3.06） us. （3.79±1.46） ng/L, P=0.041] in arterial plasma were higher in ACS group than in the control group. And the level of TIMP-1 tended to increase. The levels of MMP-3 and MMP-9 in arterial plasma were higher after stenting than before stenting. It reached a peak in the first 48 hours, and was still significantly increased in one week. The level of TIMP-1 was similar, but it reached the peak slowly. Before stenting, the level of MMP-9 was higher in restenosis group than in non restenosis group[（17.94±6.44） vs. （9.93±2.19） ng/L, P= 0. 003], but there were no differences between the two groups in the levels of TIMP-1 and MMP-3. During follow up, the levels of MMP-3[（21. 66±2. 72） vs. （14.27±1.28） ng/L, P=0.033]and MMP-9[（22. 81±5. 31） vs. （12. 10±2.76） ng/L, P=0. 039 were higher in the restenosis group than in the non-restenosis group, but there was no difference between the two groups in the level of TIMP-1. Conclusions The increase of MMP-3 and MMP-9 in arterial plasma may contribute to the pathophysiological progress after stenting in patients with ACS, which may be a prediction for restenosis.

关 键 词：冠状动脉疾病 血管成形术 经腔 经皮冠状动脉 基质金属蛋白酶类 

分 类 号：R686[医药卫生—骨科学]