冠心病并慢性心衰患者血浆ADAMTs-1、MMPs变化及其临床意义

Change of plasma ADAMTs-1 and MMPs levels in patients with coronary heart disease complicated with chronic heart failure and its significance

目的探讨冠心病（CHD）并慢性心衰（CHF）患者血浆含TSP结构的去整合素金属蛋白酶1（ADAMTs-1）、基质金属蛋白酶（MMPs）变化的临床意义。方法选取经冠脉造影确诊的CHD患者89例,其中并CHF 68例（CHF组）,NYHA心功能分级Ⅱ~Ⅳ级;心功能正常21例（对照组）。采用ELISA法检测其血浆N末端脑钠肽前体（NT-proBNP）、ADAMTS-1、基质金属蛋白酶-2（MMP-2）、MMP-9;行心脏彩超检查,测定其左室舒张末内径（LVEDd）和左室射血分数（LVEF）;SYNTAX积分法评价两组冠脉病变程度。分析ADAMTs-1、MMP-2、MMP-9与NT-proBNP、LVEDd、LVEF和SYNTAX积分的相关性。结果 CHF组NT-proBNP、MMP-2、MMP-9明显高于对照组（P均〈0.05）,且随心衰程度加重呈递增趋势（P〈0.05）;其MMP-2与NT-proBNP、LVEDd、LVEF有良好的相关性,MMP-9与NT-proBNP、LVEDd、LVEF有良好的相关性（P均〈0.01）。CHF组ADAMTs-1无明显升高（P〉0.05）,但其与SYNTAX积分呈正相关（P〈0.01）。结论血浆MMP-2、MMP-9可能参与CHD并CHF的心室重构过程,检测CHD并CHF患者的MMP-2、MMP-9有助于其诊断和心衰程度评估;ADAMTs-1可反映CHD患者的冠脉病变程度。

Objective To investigate the plasma levels of a disintegrin and metalloprotease（ADAMTS-1） and matrix metalloproteinase（MMPs） in patients with coronary heart disease（CHD）complicated with chronic heart failure（CHF）.Methods A total of 89 patients with angiographical CHD were recruited,of which 68 patients complicated with CHF were selected as the CHF group,NYHA lassification was Ⅱ~Ⅳ,and another 21 patients without CHF were served as the control group.Plasma ADAMTs-1,MMP-2,MMP-9 and N-terminal fragment of the pro-peptide of brain natriuretic peptide（NT-proBNP） were determined by ELISA method.Left ventricular end-diastolic dimension（LVEDd） and left ventricular ejection fraction（LVEF） were measured with cardiac color ultrasonography.Severity of coronary artery lesion was evaluated by SYNTAX integral method.The correlations of ADAMTs-1,MMP-2,MMP-9,NT-proBNP,LVEDd,LVEF,SYNTAX score were analyzed.Results Plasma NT-proBNP,MMP-2 and MMP-9 levels in HF group were higher than those in the control group（all P0.05）,and evidently increased with the increased severity of heart failure（P0.05）.Plasma MMP-2 and MMP-9 levels were positively related with NT-proBNP and LVEDd,and negatively related with LVEF（P0.01）.There was no significant difference in plasma ADAMTs-1 level between the CHF group and the control group,but plasma ADAMTs-1 level was positively related with the SYNTAX score（P0.01）.Conclusions Plasma MMP-2 and MMP-9 may be involved in ventricular remolding of patients with CHD complicated with CHF.Measuring plasma MMP-2 and MMP-9 concentration of patients with CHD complicated with CHF may be helpful to diagnose and evaluate the severity of heart failure.ADAMTs-1 may be a indicator of coronary artery lesions.