心肌重构水平监测在慢性心衰患者病情评估中的临床意义  

Assessment of Cardiac Remodeling in Patients with Chronic Heart Failure Condition and the Clinical Significance

作　　者：贺光林 叶吉云[2] 

机构地区：[1]石嘴山市第二人民医院重症医学科,宁夏石嘴山753000 [2]昆明医科大学,云南昆明650500

出　　处：《昆明医科大学学报》2013年第11期72-75,共4页Journal of Kunming Medical University

基　　金：云南省应用基础研究计划基金资助项目(2011FB150)

摘　　要：目的探讨MMP-9、TIMP-1检测对评估慢性心衰发生及发展的意义.方法观察组为慢性心衰患者127例,对照组选自社区健康人群40例研究对象,分别检测血MMP-9、TIMP-1并进行超声心动图检查明确LVEF及E/E'.结果观察组患者MMP-9显著高于对照组(P<0.01),TIMP-1较对照组有显著性下降(P<0.05),MMP-9/TIMP-1较对照组存在显著性升高(P<0.05).观察组LVEF、E/E'较对照组差异具有显著统计学意义(P<0.05).观察组心功能III级MMP-9、MMP-9/TIMP-1较心功能II级者出现显著性升高(P<0.05),TIMP-1较心功能II级者出现极显著性下降(P<0.05).LVEF、E/E'较心功能II级者有显著性升高(P<0.05).心功能IV级患者MMP-9、TIMP-1、MMP-9/TIMP-1均较心功能II、III级患者显著差异(P<0.05),LVEF、E/E'较心功能II级者有显著性升高(P<0.05),但较III级患者并无显著性差异(P>0.05).MMP-9+TIMP-1+MMP-9/TIMP-1较MMP-9、TIMP-1、MMP-9/TIMP-1单一指标具有更高的灵敏度及特异度,而LVEF+E/E'联合诊断价值较IL-18+NT-ProBNP为差.结论 MMP-9、TIMP-1及其比值测定有助于慢性心衰早期发现与诊断,并有助于判断病情进展.Objective To investigate the significance of MMP-9 and TIMP-1 test for assessing the occurrence and development of chronic heart failure.Methods One hundred and twenty-seven patients with chronic heart failure were enrolled in the observation group,and 40 cases community health people were selected for the control group. The levels of serum MMP-9 and TIMP-1 were detected and the LVEF and E/E ＇ were evaluated using endocardiography. Results Compared with the control group, the level of MMP-9 was significantly higher （〈0.01） but the level of TIMP-1 had significantly decreased （ 〈0.05） in the observation group. And the ratio of MMP-9 and TIMP-1 had significantly increased compared with the control group （ 〈0.05） . There were statistically significant differences of LVEF and E/E＇ between the observation group and control group （ 〈0.05） . In the observation group,the level of MMP-9, MMP-9/TIMP-1,LVEF and E/E＇ were increased but the level of TIMP-1 decreased significantly in cases with cardiac functional class III compared with cardiac function class II （〈0.05） . There were significant differences between the cases with class IV heart function and class II, III in the levels of MMP-9, TIMP-1 and MMP-9/TIMP-1 （ 〈0.05） . In the cases of class IV heart function, the LVEF and E/E＇ have significantly increased compared with the cases of class II （ 〈0.05） . MMP-9 ＋ TIMP-1 ＋MMP-9/TIMP-1 combination has higher sensitivity and specificity than the MMP-9,TIMP-1 and MMP-9/TIMP-1 single indicator, and the joint diagnostic value of LVEF ＋ E/E＇ was less than that of IL-18＋ NT-ProBNP. Conclusion The levels of MMP-9 and TIMP-1 and their ratio may have contributed to the early detection and diagnosis for chronic heart failure,and help to determine the disease progression.

关 键 词：MMP-9 TIMP-1 慢性心衰 超声心动图 

分 类 号：R614.2[医药卫生—麻醉学]