基质金属蛋白酶-9在冠心病心绞痛患者危险分层中的作用

目的：研究基质金属蛋白酶-9（MMP-9）水平变化在心绞痛危险分层中的作用。方法：将161例连续行冠状动脉造影的患者根据MMP-9血清测定值四分位数法分成四组：A组≤108．2ng／ml，B组108．2～171．3ng／ml，C组171．3～239．8ng／ml，D组〉239．8ng／ml。观察各组临床事件、理化指标的差异；用多元逐步回归法计算MMP-9与多因素的相关性；比较A、B组与C、D组患者的6个月随访终点事件的累计发生率。结果：（1）不稳定型心绞痛（UAP）患者93．5％（58／62）分布于C、D组，与A、B组比较P〈0．001，其中59．7％（37／62）分布于D组，是A组的37倍（P〈0．001）。（2）C组的Gensini积分（49．3±12．5）最高，与A组（11．2±7．8）相比P〈0．001，与D组（37．5±12．4）比较P〈0．05。（3）血清MMP-9水平和hs-CRP水平呈正相关（r=0．65，P〈0．01）。MMP-9≤239．8ng／ml时MMP-9与Gensini积分呈正相关（r=0．53，P〈0．01），MMP-9〉239．8ng／ml时MMP-9与Gensini积分无相关性。（4）C、D组患者6个月随访心血管终点事件累计发生率明显高于A、B组（χ^2=14．8，P〈0．01）。结论：MMP-9在评价UAP患者斑块稳定性及在危险分层上可能是一个重要的生物学指标，尤其在识别高危的临界冠脉病变中可能有重要意义。

Role of Matrix Metalloproteinase 9 in Risk Stratification of Patients with Angina Pectoris

Objective：To investigate the role of matrix metalloproteinase 9（MMP-9） in risk stratification of patients with angina pectoris. Methods： 161 patients with angina pectoris underwent coronary angiography were divided into four groups according to quartile of MMP-9 level. Group A：≤108.2 ng/ml,group B：108.2～171.3 ng/ml,group C：〉 171. 3 ～ 239. 8 ng/ml,group D： 〉 239. 8 ng/ml. Relationship between MMP-9 and multi-elements was analyzed with multiple progressively regression and clinical endpoints within 6 months were observed. Results： （1） 93.5%（58/62） of patients with unstable angina pectoris（UAP） were in groups C and D, which was remarkable higher than the percentage in groups A and B（P〈0. 001）. 59. 7%（37/62） of patients with UAP were in group D,37 folds of the percentage in group A（P〈0. 001）. （2） Gensini Score（49. 3±12. 5） in group C was highest,significantly higher than the Score of group A（P%0.001） and group D（P〈.05）. （3）MMP-91evel positively correlated with hs-CRP level（r=0.65,P〈 0. 01）. It also positively correlated with Gensini Score（r=0.53,P〈0. 01） while MMP-9 level was lower than 239, 8ng/ ml ,however,no correlation was observed while MMP-9 level was higher than 239.8ng/ml. （4） Cumulative incidence of clinical endpolnts within 6 months was statistically different between MMP-9≤171.3 ng/ml group and 〉171.3 ng/ml group （χ^2= 14.8,P% 0. 01）. Conclusion： MMP-9 level may be an important biomarker in assessment of atherosclerotic plaque stability and risk stratification in UAP patients, especially in identification of high-risk intermediate coronary stenosis patients.