不同类型冠心病患者血浆脑钠肽、基质金属蛋白酶及其抑制物、超敏C反应蛋白水平的变化

目的:观察不同类型冠心病患者的血浆脑钠肽(BNP)和基质金属蛋白酶9 (MMP-9)、基质金属蛋白酶组织抑制因子-1(TIMP-1)及超敏C反应蛋白(hsCRP)水平的变化,探讨其临床意义.方法:113例均经冠状动脉造影确诊的冠心病(CHD)患者,按临床类型分为:急性心肌梗死(AMI)组36例,不稳定型心绞痛(UAP)组46例,稳定型心绞痛(SAP)组31例;另选30例非CHD者作对照组.分别采用化学发光法、ELISA及透射比浊法检测入院次日血浆BNP、MMP-9、TIMP-1及hsCRP的水平.结果:AMI组、UAP组、SAP组和对照组血浆BNP水平分别为(656.80±351.49)、(216.23±144.42)、(57.17±36.77)、(39.57±30.21)ng/L;MMP-9水平分别为(242.57±69.62)、(166.29±58.47)、(69.31±18.39)、(64.56±16.49)μg/L;TIMP-1水平分别为(196.83±56.57)、(159.23±45.41)、(83.69±14.31)、(81.95±13.28)μg/L;MMP-9/TIMP-1比值水平分别为1.30±0.39、1.06±0.32、0.82±0.14、0.80±0.22;hsCRP水平分别为(23.08±5.19)、(13.80±2.51)、(4.92±2.98)、(3.94±2.33)mg/L.AMI组血浆BNP、MMP-9、TIMP-1、MMP-9/TIMP-1及hsCRP水平明显高于UAP组(P<0.05),UAP组各项指标明显高于SAP组和对照组(P<0.05),SAP组与对照组各项指标水平比较差异无统计学意义(P>0.05).BNP与hsCRP、MMP-9水平变化呈正相关,与左室射血分数呈负相关.结论:不同临床类型CHD患者的血浆BNP、MMP-9、TIMP-1、MMP-9/TIMP-1及hsCRP水平不同,提示上述指标对CHD患者进行危险分层及分析预后有一定临床价值.

Study of the changes of plasma levels of BNP, MMP-9,TIMP-1 and hsCRP in the patients with different clinical phenotypes of coronary heart disease

Objective:To observed the changes of plasma levels of BNP, MMP-9,TIMP-1 and hsCRP in patients with different types of coronary heart disease and investigate its clinical value. Method:The total of 113 patients with CHD diagnosed by selected coronary angioplasty were enrolled in this study, including 36 cases of acute myocardial infarction(AMI),46 cases of unstable angina(UAP) and 31 cases of stable angina(SA). And 30 persons without CHD were selected as the control. Plasma levels of BNP, MMP-9, TIMP-1 and hsCRP were detected by the methods of chemoluminescence, ELISA and turbidimetry, respectively. Result:Plasma BNP levels of AMI, UAP, SAP and control group were (656.80±351.49), (216.23±144.42),(57.17±36.77) and (39.57±30.21)ng/L, respectively. Plasma MMP-9 levels of AMI, UAP, SAP and control group were (242.57±69.62), (166.29±58.47), (69.31±18.39) and( 64.56±16.49)μg/L, respectively. Plasma TIMP-1 levels of AMI, UAP, SAP and control group were (196.83±56.57), (159.23±45.41), (83.69±14.31) and (81.95±13.28)μg/L, respectively. Ratios of MMP-9/TIMP-1 were 1.30±0.39, 1.06±0.32, 0.82±0.14 and 0.80±0.22, respectively. Plasma hsCRP levels were (23.08±5.19), (13.80±2.51), (4.92±2.98) and (3.94±2.33)mg/L, respectively. Plasma levels of BNP, MMP-9, TIMP-1, MMP-9/TIMP-1 and hsCRP in AMI group were obviously higher than those in UAP group (P<0.05). Au makers in UAP group were obviously higher than those in SAP group(P<0.05).There was no significant differences of these markers between SAP group and control group. Plasma BNP levels were positively correlated with plasma hsCRP and MMP-9 levels and negatively correlated with LVEF. Conclusion:Plasma levels of BNP, MMP-9, TIMP-1 and hsCRP are associated with different clinical phenotyes of CHD. Those markers may be helpful to the risk-stratification and prognosis of CHD.