川崎病患儿血清MMP-9与TIMP-1质量浓度变化及其临床意义

目的探讨川崎病(KD)患儿血清基质金属蛋白酶-9(MMP-9)及其特异性组织抑制剂1(TIMP-1)质量浓度的变化在预测发生冠状动脉病变(CAL)风险中的临床意义。方法观察组为2003~2004年在四川大学华西第二医院与四川省人民医院住院的KD患儿32例,静脉注射丙种球蛋白(IVIG)前后各抽取患儿外周静脉血1次,同时抽取20名正常体检儿童(正常对照组)外周静脉血。ELISA双抗体法测定血清MMP-9与TIMP-1质量浓度。用二维超声心动图观察心脏冠状动脉病变。结果观察组患儿急性期血清MMP-9、TIMP-1质量浓度及MMP-9/TIMP-1比值均较正常对照组儿童显著增高(P<0.01);IVIG干预前CAL组患儿血清MMP-9质量浓度及血清MMP-9/TIMP-1显著地高于非CAL组患儿(P<0.01);IVIG干预后观察组患儿血清MMP-9质量浓度与MMP-9/TIMP-1显著降低(P<0.01);IVIG干预后CAL组患儿血清MMP-9质量浓度及血清MMP-9/TIMP-1仍显著高于非CAL组患儿(P<0.05),而后者MMP-9/TIMP-1基本降至正常儿童水平;观察组患儿血清TIMP-1质量浓度在IVIG干预前后无显著变化。结论MMP-9与TIMP-1可作为KD合并CAL的一种关联因素,动态监测血清MMP-9质量浓度和(或)MMP-9/TIMP-1比值对预测KD并发CAL具有较重要临床意义。

Dynamic changes of serum MMP-9 and TIMP-1 levels in patients with Kawasaki disease

Objective To investigate the clinical value of serum matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels assay in predicting risk of coronary artery lesion (CAL) in patients with Kawasaki disease (KD).Methods Thirty-two in-patient children with KD were recruited from West China Second Hospital of Sichuan University and People's Hospital of Sichuan Province from 2003 to 2004,whose venous blood samples were obtained before and after intravenous immunoglobulin (IVIG) therapy.And CAL was detected with 2D-echocardiography and coronary angiographer.20 venous blood samples of normal physical examination children were gained as controls.Serum levels of MMP-9 and TIMP-1 were measured by rapid one-step sandwich enzyme immunoassay in 32 cases and 20 control children.Results In acute phase serum MMP-9,TIMP-1 levels and the ratio of MMP-9/TIMP-1 were significantly higher (P<0.01)in KD than that of controls.Before IVIG therapy serum MMP-9 level and the ratio of MMP-9/TIMP-1 were significantly higher(P<0.01) in patients with CAL than that in patients without CAL.After IVIG therapy in KD patients serum MMP-9 level and the ratio of MMP-9/TIMP-1 decreased significantly (P<0.01),and in patients without CAL these data were similar to that of controls,but in patients with CAL serum MMP-9 level and the ratio of MMP-9/TIMP-1 were still significantly higher (P<0.05)than that of the patients without CAL and controls.Significant variety of serum TIMP-1 level of KD patients was not observed after IVIG therapy.Conclusion Serum MMP-9 level and the ratio of MMP-9/TIMP-1 might be a kind of correlative factor of KD coronary arterial lesion,which implies that it has important clinical value in predicting risk of KD coronary artery lesion to assay serum MMP-9 and TIMP-1 level continuously.