血浆基质金属蛋白酶2和组织型基质金属蛋白酶抑制剂2水平变化与急性冠状动脉综合征的关系

目的 探讨不同类型冠心病患者基质金属蛋白酶2、组织型基质金属蛋白酶抑制剂2水平及其比值变化,分析其在急性冠状动脉综合征中的临床意义.方法 经冠状动脉造影的118例心内科住院患者,依据其临床表现和冠状动脉造影结果分组:急性冠状动脉综合征患者49例,其中包括不稳定型心绞痛患者30例、急性心肌梗死患者19例;非急性冠状动脉综合征冠心病患者44例,包括稳定型心绞痛患者23例、冠状动脉慢性完全闭塞患者21例;25例冠状动脉正常患者为对照组.采用夹心酶联免疫吸附法检测动脉血浆基质金属蛋白酶2和组织型基质金属蛋白酶抑制剂2水平.结果 急性冠状动脉综合征和非急性冠状动脉综合征患者血浆基质金属蛋白酶2、组织型基质金属蛋白酶抑制剂2水平均明显高于对照组(P<0.05),且基质金属蛋白酶2/组织型基质金属蛋白酶抑制剂2比值均显著高于对照组(P<0.01);与非急性冠状动脉综合征患者比较,急性冠状动脉综合征患者基质金属蛋白酶2、组织型基质金属蛋白酶抑制剂2水平及基质金属蛋白酶2/组织型基质金属蛋白酶抑制剂2比值均显著增高(P<0.05和P<0.01);与对照组比较,不稳定型心绞痛组、急性心肌梗死组和冠状动脉慢性完全闭塞组基质金属蛋白酶2水平明显增高(P<0.05和P<0.01),不稳定型心绞痛组、稳定型心绞痛组和冠状动脉慢性完全闭塞组组织型基质金属蛋白酶抑制剂2显著增高(P<0.05和P<0.01).结论 动脉粥样硬化斑块的演变与血基质金属蛋白酶2、组织型基质金属蛋白酶抑制剂2水平及基质金属蛋白酶2/组织型基质金属蛋白酶抑制剂2比值变化和失衡密切相关,基质金属蛋白酶2水平和基质金属蛋白酶2/组织型基质金属蛋白酶抑制剂2比值显著升高提示动脉粥样硬化斑块的不稳定性,有可能作为急性冠状动脉综合征病情严重程度的有效预测指标之一.

Plasma Levels of Matrix Metalloproteinase-2 and Tissue Inhibitor of Matrix Metalloproteinase-2 and Its Relationship with Acute Coronary Syndrome

Aim To investigate the changes of plasma matrix metalloproteinase-2(MMP-2),tissue inhibitor of matrix metalloproteinase-2(TIMP-2) level and MMP-2/TIMP-2 ratio in patients with different types of coronary heart disease(CHD),and discuss clinical significances. Methods A total of 118 patients were divided cardioangiographically and clinically into following groups: acute coronary syndrome(ACS) group with 49 cases including unstable angina pectoris(UAP) subgroup with 30 cases and acute myocardial infarction(AMI) with 19 cases;non-ACS group with 44 cases including stable angina pectoris(SAP) with 23 cases and chronic total occlusion of coronary artery(CTO) with 21cases;and normal coronary artery group as a control with 25 cases.The plasma levels of MMP-2 and TIMP-2 were assayed by enzyme-linked immunosorbent assay(ELISA). Results Compared with normal coronary artery group,remarkably elevated plasma MMP-2 level was observed in ACS group and non-ACS group(both P<0.05),and the increasing of MMP-2/TIMP-2 ratio was significant(P<0.01) in both ACS and non-ACS groups.MMP-2 and TIMP-2 level and MMP-2/TIMP-2 ratio were obviously higher in ACS group than that in non-ACS group(P<0.05 or P<0.01).MMP-2 level was increasing more in UAP subgroup(P<0.05),AMI subgroup(P<0.05),and CTO subgroup(P<0.01) compared with normal coronary artery group,respectively.Comparison between normal coronary artery group with each subgroup,concentration of TIMP-2 was higher in UAP subgroup(P<0.05),SAP subgroup(P<0.001),and CTO subgroup(P<0.01),respectively. Conclusion The developing of atherosclerosis plaque was associated with plasma MMP-2 level,TIMP-2 level and imbalance of MMP-2/TIMP-2 proportion in CHD patients.The increased MMP-2 level and imbalance of MMP-2/TIMP-2 proportion in patients with CHD suggested instability of atherosclerotic plaque,and might be viewed as one of predictable biomarkers for occurrence of ACS event.