急性冠状动脉综合征患者颈动脉斑块与血浆基质金属蛋白酶的相关性

The Relationships Between Carotid Plaque and Plasma Matrix Metalloproteinase in Patients with Acute Coronary Syndrome

目的研究急性冠状动脉综合征患者颈动脉斑块与血浆基质金属蛋白酶的相关性。方法采用高分辨率超声,测定30例急性冠状动脉综合征患者、29例稳定型心绞痛患者和17例正常对照者的颈动脉内膜中膜厚度及斑块积分,同时采用夹心酶联免疫分析法测定血浆基质金属蛋白酶9和组织型金属蛋白酶抑制因子1的变化。结果三组间的年龄、性别、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇无显著性差异。急性冠状动脉综合征组血浆基质金属蛋白酶9、组织型金属蛋白酶抑制剂1、基质金属蛋白酶9/组织型金属蛋白酶抑制剂1及颈动脉内膜中膜厚度、总斑块积分、软斑块积分和硬斑块积分显著高于稳定型心绞痛组和正常对照组。基质金属蛋白酶9与颈动脉内膜中膜厚度、总斑块积分、软斑块积分呈正相关(r=0.468,P<0.01;r=0.592,P<0.01;r=0.677,P<0.01);组织型金属蛋白酶抑制剂1与颈动脉内膜中膜厚度、总斑块积分、软斑块积分、硬斑块积分呈正相关(r=0.449,P<0.01;r=0.493,P<0.01;r=0.435,P<0.01;r=0.227,P<0.05);基质金属蛋白酶9/组织型金属蛋白酶抑制剂1与颈动脉内膜中膜厚度、总斑块积分、软斑块积分呈正相关(r=0.253,P<0.05;r=0.431,P<0.01;r=0.547,P<0.01)。去除年龄因素后,偏相关分析显示颈动脉内膜中膜厚度与基质金属蛋白酶9(r=0.461,P<0.001)、组织型金属蛋白酶抑制剂1(r=0.441,P<0.001)、基质金属蛋白酶9/组织型金属蛋白酶抑制剂1(r=0.241,P<0.01)呈正相关关系。结论急性冠状动脉综合征患者血浆基质金属蛋白酶9、组织型金属蛋白酶抑制剂1、基质金属蛋白酶9/组织型金属蛋白酶抑制剂1及颈动脉内膜中膜厚度、总斑块积分、软斑块积分和硬斑块积分显著高于稳定型心绞痛患者和正常对照。血浆基质金属蛋白酶9、组织型金属蛋白酶抑制剂1、基质金属蛋白酶9/组织型金属蛋白酶抑制剂1与颈动脉内膜中膜厚度、总斑块积分、软斑块积分呈正相关关系。

Aim To study the relationships between carotid plaque and plasma matrix metaUoproteinase and tissue inhibitor metaUoproteinase in patients with acute coronary syndrome （ACS）. Methods Using high-resolution ultrasonic instrument the intima-media thickness （IMT）and plaque score in carotid artery were detected in 30 patients with ACS, 29 patients with stable angina pectoris （SAP） and 17 control subjects, and the plasma concentration of matrix metalloproteinase-9 （MMP-9）and tissue inhibitor metaUoproteinase-1 （TIMP-1）were measured by sandwich enzyme immunoassay technique. Results Compared with SAP group and control group, plasma MMP-9, TIMP-1, MMP-9/TIMP-1, and IMT, whole plaque score, soft plaque score and hard plaque score in carotid artery in ACS group were significantly increased （ P 〈 0.01 ）. MMP-9 had positive relationship with IMT, whole plaque score and soft plaque score in carotid artery （ r = 0.468, P 〈0.01; r=0.592, P 〈0.01; r = 0.677, P 〈 0.01）, respectively. TIMP-1 had positive relationship with IMT, whole plaque score, soft plaque score and hard plaque score in carotid artery （r=0.449, P〈0.01; r=0.493, P〈0.01; r=0.435, P〈0.01; r=0.227, P〈0.05）, respectively. MMP-9/TIMP-1 had positive relationship with IMT, whole plaque score and soft plaque score in carotid artery （ r = 0.253, P〈0.05; r=0.431, P〈0.01; r=0.547, P〈0.01）, respectively. Removing age factor, partial correlation analysis showed IMT had positive relationship with MMP-9 （r=0.461, P〈0.001）, TIMP-1 （r=0.441, P〈0.001）, MMP-9/TIMP-I （r=0.241,P 〈0.01）, respectively. Conclusions Plasma MMP-9, TIMP-1, MMP-9/TIMP-1, and IMT, whole plaque score, soft plaque score and hard plaque score in carotid artery in ACS group are significantly higher than those in SAP group and control group. Plasma MMP-9, TIMP-1, MMP-9/TIMP-1 have positive relationship with IMT, whole plaque score and soft plaque score in carotid artery, respectively.