急性冠脉综合征患者MIF MMP-9表达及PCI术后动态变化

目的探讨巨噬细胞移动抑制因子（MIF）和基质金属蛋白酶-9（MMP-9）在急性冠脉综合征患者血清中的变化及经皮冠状动脉介入治疗（PCI）对其的影响。方法将120例临床诊断并经冠状动脉造影（CAG）证实的冠心病患者,分为稳定型心绞痛（SAP）组40例,不稳定型心绞痛（UAP）组42例和急性心肌梗死（AMI）组38例,另外选取CAG结果正常的30例患者作为正常对照组。所有患者均于入院次日清晨空腹抽取静脉血5 mL,UAP组和AMI组行PCI术治疗的还分别于术后6 h,1,2,3,7,14,21,28 d采血,采用酶联免疫吸附试验（ELISA）分别检测血清MIF、MMP-9水平。结果 AMI组、UAP组血清MIF、MMP-9水平均显著高于SAP组及对照组（P〈0.01）;不同冠脉病变支数之间血清MIF、MMP-9水平比较差异均无显著性（P〉0.05）;不同冠脉狭窄程度之间血清MIF、MMP-9水平比较差异均无显著性（P〉0.05）;急性冠脉综合征（ACS）患者MIF与MMP-9之间的相关性：ACS患者血清MIF与MMP-9水平呈正相关（r=0.78,P〈0.05）;PCI术后MIF、MMP-9表达水平较术前明显增高：MIF术后2 d达到高峰,然后缓慢下降,28 d回复术前水平;MMP-9术后1 d达到高峰,然后缓慢下降,21 d回复术前水平。结论血清MIF、MMP-9水平与冠脉斑块不稳定性有关,而与冠脉狭窄程度无关,且MIF与MMP-9之间存在正相关;PCI术可能加重了术后冠脉内早期炎症反应。

Expression of MIF and MMP-9 in acute coronary syndrome and dynamic change after PCI

Objective To explore expression of serum levels of macrophage migration inhibitory factor(MIF) and matrix metalloproteinase-9(MMP-9) and dynamic change after PCI in acute coronary syndrome(ACS).Methods 120 patients with coronary heart disease were selected according to the results of coronary angiography and clinical manifestation.They were divided into three groups: SAP group(n=40),UAP group(n=42) and AMI group(n=38). 30 patients with negative CAG results were selected as normal control group.The blood samples with 5 mL were drown from venous in morning of the following day after hospitalization.In addition,the blood samples were drown from venous of patients undergoing PCI operation on 6 h,1,2,3,7,14,21 d and 28d after PCI.The serum levels of MIF and MMP-9 were delected by enzyme-linked immunosorbent assay(ELISA).Results The concentrations of MIF and MMP-9 in AMI group and UAP group were significantly higher than those in SAP and control group(P<0.05).Neither MIF nor MMP-9 was statistical difference among one-vessel,two-vessel and three-vessel group(P>0.05).Neither MIF nor MMP-9 was statistical difference among mild,middle and serious stenosis group in patients with ACS(P>0.05).Correlation analysis between MIF and MMP-9 in patients with ACS: Serum MIF level was positively relative to serum MMP-9 level in ACS group(r=0.78,P<0.05).MIF and MMP-9 expression level is increased sharply after PCI.The MIF expression achieve peak level at day 2,then decrease slowly,it revive preoperative levels at day 28.MMP-9 expression achieve peak level at day 1,then slow drop,decrease slowly,it revive preoperative levels at day 21.Conclusion Serum MIF and MMP-9 levels are related to the unstability of coronary artery plaque.They are no relation with the degree of coronary artery stenosis.There is positive correlation between MIF and MMP-9.PCI technology aggravate the early intravascular inflammation after postoperative.