不稳定型心绞痛介入治疗后基质金属蛋白酶9的表达改变对预后的影响

目的探讨基质金属蛋白酶9(MMP-9)对经皮冠状动脉介入治疗(PCI)不稳定型心绞痛(UAP)预后的预测作用。方法 136例UAP患者常规行PCI治疗,于术前1 d和术后1 d清晨分别抽取空腹血,酶联免疫吸附法检测MMP-9。系统随访6个月,记录重要心脏不良事件(MACE)的发生情况。结果 MMP-9浓度由术前1 d的(15.9±2.5)ng/mL下降为术后1 d的(10.9±2.3)ng/mL(t=17.165,P=0.000),平均MMP-9下降率为31.4%。随访半年内,发生MACE共19例(14.0%)。术后发生MACE患者的MMP-9浓度为(13.9±2.5)ng/mL,高于未发生MACE患者的MMP-9浓度(10.5±2.4)ng/mL(t=11.441,P=0.000)。MMP-9下降率对MACE发生预测的ROC曲线下面积为0.723,95%CI为0.624～0.754。下降率截断值为15%时,预测特异度为78.5%,灵敏度为82.1%。预后分析显示,MMP-9下降率≤15%的MACE发生率高于MMP-9下降率>15%患者(χ2=2.579,P=0.038)。Cox多因素调整后,其MACE发生OR为1.454。结论 MMP-9下降程度对不稳定型心绞痛介入治疗后的预后具有较好的预测作用。当MMP-9下降率在15%以内时,重要心脏不良事件的发生概率较高。

The prognostic value of matrix metalloproteinase-9 in predicting unstable angina pectoris after percutaneous coronary intervention

Objective To investigate the prognostic values of matrix metalloproteinase-9(MMP-9) in predicting unstable angina pectoris(UAP) after the PCI(Percutaneious coronary intervention) treatment.Methods A total of 136 patients with UAP were treated with PCI.Blood samples were collected pre-and postoperatively.Enzyme-linked immunosorbent assay was used to detect MMP-9.We recorded important adverse cardiac events(MACE) in a 6-month follow-up.Results The MMP-9 concentration dropped after the operation(preoperative 15.9 ± 2.5 ng / mL vs postoperative 10.9±2.3 ng / mL,t=17.165,P=0.000).The average MMP-9 decrease rate was 31.4%.Within a 6-month follow-up,19 patients had MACE(14.0%).The postoperative MMP-9 concentration in MACE patients was higher than those without MACE(13.9 ± 2.5 ng / mL vs 10.5 ± 2.4 ng / mL,t=11.441,P=0.000).The area under the ROC curve of MMP-9 decrease rate to predict MACE was 0.723,95% CI of 0.624-0.754.If the cut-off was set at 15%,the specificity was 78.5%,while the sensitivity was 82.1%.Prognostic analysis showed that the incidence of MACE in the group with MMP-9 decreased rate not above 15% was higher than those below 15%(χ2=2.579,P=0.038).Adjusted by Cox multivariate,OR for the occurrence of MACE was 1.454(≤15% vs>15%).Conclusion Matrix metalloproteinase-9 can predict the prognosis for unstable angina pectoris after percutaneous coronary intervention.When the decreasing rate of MMP-9 is below 15%,more attention should be paid for the occurrence of major adverse cardiac events.