冠心病患者常规支架术和直接支架术后MMP-9的变化及意义

Changes and Significance of MMP-9 After Conventional Stenting and Direct Stenting for Patients with Coronary Heart Disease

【目的】观察冠心病患者支架置入术后基质金属蛋白酶-9(MMP-9)的动态变化,比较常规支架术和直接支架术后MMP-9变化的差异及意义。【方法】选择常规支架术和直接支架术的患者各28例,比较在支架置入前,置入后即刻、置入后24 h,MMP-9两组间的差异,所有患者随访6个月,观察术后主要不良心血管事件的发生情况。【结果】常规支架组和直接支架组在支架置入前MMP-9略高于正常,但两组间差异无显著性,支架置入后即刻开始升高,24 h升高明显,在24 h时两组间差异有显著性(P<0.01)。常规支架组总的不良心血管事件发生率为25.0%,直接支架组总的不良事件发生率7.5%,两组间比较差异有显著性(P<0.05),并且不良事件发生率的高低与出院时的MMP-9高低相一致。【结论】常规支架术由于反复的球囊预扩张,内膜损伤重,术后炎症反应剧烈,其远期并发症明显多于直接支架术,对一些合适病变,可以首选直接支架术。

[Objective]To observe the changes of serum matrix metalloproteinases-9（MMp-9） after stenting. find out the difference between conventional stenting and direct stenting,and to explore the different prognostic meanings between 2 groups. [Methods]Tweenty-eight conventional stenting patients and 28 direct stenting patients were selected and their blood samples were collected before stenting,immediately,at 24 hours. The blood levers of MMP-9 were detected with ELISA. All patients were followed up for 6 months. [Resuhs]Before stenting,the serum MMP-9 did not have significant difference in the 2 groups,but began to rise shortly after stenting and was apparently higher at 24h. At the moment of 24h,the difference of the two groups were significant（P〈0.01）. After followed up for 6 months the incidence of the total cardiac events was 21.4% in conventional stenting group and 7. 1% in direct stenting group, the differance was also significant （ P〈0. 05）. More importantly, the incidence of the total cardiac events was corresponding to the level of MMP-9 in 24 hours after stenting. [Conclusion]Becaues of repeated dilation with balloon, the damage to intima is more serious in conventional stenting group, and the inflammation is more dramatie too. so the long term complications of conventional stenting are much more than those in direct stenting, therefore to some appropriate lesions, direct stenting should be selected first.