心肌梗死患者右心房基质金属蛋白酶表达水平的变化

Comparison of right atrial matrix metalloproteinase expression between patients with unstable angina and myocardial infarction

目的 研究冠心病心肌梗死（MI）患者右心房组织基质金属蛋白酶（MMP）及其抑制剂（TIMP）的基因表达,探讨其与右心房结构重构的关系.方法 选取因冠心病接受冠状动脉旁路移植术（CABG）的患者40例,其中MI 22例,不稳定性心绞痛（UA）组18例,术前进行超声心动图检查.于开胸手术时取右心耳标本,分别进行免疫组织化学染色检查、荧光定量PCR方法检测标本中MMP-1、MMP-3、MMP-7、MMP-9及TIMP-1表达.结果 MI组左右心房内径及左心室内径均大于UA组[左心房内径：（40.8±4.2）mm比（33.1±5.1）mm,P〈0.01;右心房内径：（44.1±6.8）mm比（28.8±6.0）mm,P〈0.01;左心室内径：（48.9±6.0）mm比（39.7±7.1）mm,P〈0.01],心房组织中MMP-3、MMP-9及TIMP-1基因表达高于UA组（MMP-3：0.39±0.18比0.28±0.07,P〈0.05：MMP-9：0.81±0.21比0.55±0.20,P〈0.01;TIMP-1：1.79±0.89比0.94±0.47,P〈0.01）,MMP-1、MMP-7基因表达有增加趋势,但差异无统计学意义.结论 冠心病心肌梗死患者右心房组织MMP及TIMP表达水平的升高与右心房重构相关.

Objective To compare right atrial structural remodeling and the expression of matrix metalloproteinase （MMP） and tissue inhibitors（TIMP） between patients with unstable angina （UA） and myocardial infarction （MI）. Methods Right atrial appendages were obtained from 18 patients with UA and 22 patients with MI undergoing coronary artery bypass grafting （CABG） operations. MMP-1 ,-3,-7,-9 and TIMP-1 protein expressions were detected by immunohistochemistry and RT-PCR. Echocardiography was performed before CABG. Results The left and right atrial diameter, left ventricular diameter and mRNA levels of MMP-3, MMP-9 and TIMP-1 were significantly higher in MI group than those in UA group [LAD： （40. 8 ±4. 2）mm vs. （33. 1 ±5. l）mm,P 〈0. 01; RAD; （44. 1 ±6. 8） mm vs. （28. 8 ±6. 0） mm, P〈 0.0l;LVEDD： （48.9±6.0） mm vs. （39.7 ±7.1） mm, P 〈0. 05; MMP-3： 0. 39 ±0. 18 vs. 0. 28 ± 0.07, P〈0.05;MMP-9： 0.81 ±0.21 vs. 0.55 ±0.20, P〈0.01; TIMP-1： 1.79 ±0.89 vs. 0.94± 0.47, P 〈 0. 01]. MMP-1, MMP-7 levels were similar between the 2 groups （ MMP-1： 0. 14 ± 0. 06 vs. 0. 10 ± 0. 08, P 〉 0.05; MMP-7： 0. 25 ± 0.05 vs. 0. 23 ± 0. 06, P 〉 0.05）. Conclusion Right atrial up-regulation of MMP-3, MMP-9 and TIMP-1 levels may contribute to the right atrial structural remodeling in MI patients.