血清基质金属蛋白酶-9与2型糖尿病并发急性冠脉综合征的关系

Clinical Significance of Serum MMP-9 Changes in Type II Diabetic Patients Complicated with Acute Coronary Syndrome

目的观察基质金属蛋白酶-9(MMP-9)在糖尿病并发急性冠脉综合征(ACS)患者血清中的水平,评价其临床检测意义。方法选择28例健康志愿者(正常组)、27例单纯2型糖尿病患者(DM组)、52例ACS患者〔ACS组,其中不稳定型心绞痛(UAP)31例,急性心肌梗死(AMI)21例〕,46例2型糖尿病并发ACS患者〔DM+ACS组,其中糖尿病并发不稳定型心绞痛(DM+UAP)26例,糖尿病并发急性心肌梗死(DM+AMI)20例〕。用酶联免疫吸附法(ELISA)检测各组血清MMP-9水平,免疫散射比浊法(immunoturbidimetric method)检测血清C反应蛋白(CRP)水平。制作受试者工作特性曲线(ROC曲线),判断血清MMP-9检测糖尿病并发ACS的临界值。结果DM+ACS组患者血清MMP-9水平〔(307±101)μg/L〕显著高于正常组〔(164±35)μg/L〕、DM组〔(184±35)μg/L〕及ACS组〔(239±74)μg/L〕,差异有统计学意义(P<0.01);DM+AMI组患者血清MMP-9水平显著高于DM+UAP组,差异有统计学意义(P<0.01)。MMP-9水平与血清CRP水平呈正相关(γ=0.61,P<0.01)。MMP-9水平用于DM并发ACS判断的临界值为211μg/L,其敏感性为84.8%,特异性为65.4%,ROC曲线下面积为0.813。结论血清MMP-9水平在糖尿病并发ACS患者中呈相对升高状态,提示血清MMP-9变化与糖尿病患者并发ACS的发生、发展有关,可作为预测该类患者动脉粥样斑块不稳定或破裂的血清学指标。

Objective To investigate serum MMP- 9 in patients with type 2 diabetes mellitus （T2DM） complicated with acute coronary syndrome （ACS） and to evaluate its clinical significance. Methods Twenty-eight healthy subjects （normal group）, 27 T2DM patients （DM group）, 52 ACS （ACS group） including 31 with unstable angina pectoris （UAP） and 21 with acute myocardial infarction （ AMI）, and 46 T2DM accompanied by ACS （ DM ＋ UAP group） including 26 T2DM combined with UAP and 20 with AMI. Serum MMP- 9 level was detected by enzyme -linked immunosorbent assay （ELISA）, and serum C -reactive protein （CRP） by immuno -turbidimetric method. The receiver operating curve （ROC） was made and the critical value of serum MMP - 9 in detecting T2 DM combined with ACS was determined. Results MMP - 9 level was significantly higher in DM ＋ ACS group （307 ± 101 μg/L） than in groups ACS （239 ± 74μg/L）, DM （ 184 ± 35 μg/L） and control （ 164 ± 35 μg/ L）, and higher in DM ＋ AMI subgroup than DM ＋ UAP subgroup. MMP -9 level was positively correlated with serum CRP level （ T =0. 61, P 〈0. 01 ）. The critical value of MMP - 9 level for DM combined with ACS was 210. 93 μg/L, with an 84. 8% sensitivity and a 65. 4% specificity. The area under curve of ROC was 0. 813. Conclusion Serum MMP - 9 level shows a relatively higher status in T2 DM patients with ACS, suggesting that the changes of MMP -9 level is associated with the occurrence and development of ACS. It can be used as serological predictor for unstable or ruptured atherosclerotic plaques.