血清基质金属蛋白酶-1、2、3、9在胸部主动脉疾病和急性心肌缺血中的检测及意义

Significance of the detection of serum levels of matrix metalloproteinases -1,-2,-3 and -9 in thoracic aortic diseases and acute myocardial ischemia

目的探讨血清基质金属蛋白酶（MMPs）-1、2、3、9在急、慢性胸部主动脉疾病和急性心肌缺血的变化及意义。方法共80例急性主动脉夹层、慢性主动脉夹层、胸部主动脉瘤、急性心肌缺血患者及正常对照16例，采用ELISA方法检测血清MMP-1、2、3、9。结果与急性主动脉夹层组相比，急性心肌缺血组MMP-3升高，2组比较差异有统计学意义[（19．10±3．11）哕L与（11．89±1．31）ug／L，P=0．02]。与其他组相比，正常对照组MMP-1[（1．30±0．56）ug/L]明显低于急性夹层动脉瘤组[（2．99±0．78）ug/L，P=0．03]、慢性夹层动脉瘤组[（3．12±0．78）ug/L，P=0．02]、胸主动脉瘤组[（3．01±1．01）ug／L，P=0．03]、急性心肌缺血组[（5．01±0．98）ug/L，P=0．01]。MMP-1与年龄增加呈正相关（r=0．38，P〈0．05）。在急性主动脉夹层手术的患者，MMP-1、MMP-3和MMP-9含量手术后即刻较手术前升高，而MMP-2减少，差异均有统计学意义（P均〈0．05）；术后24h，MMP-1、MMP-2及MMP-9回到术前水平。结论对于胸主动脉疾病和急性心肌缺血，测定血清MMP含量为简单、快速、有效的临床指标，可在基层卫生中心开展。

Objective To evaluate the clinical significance of the change of serum matrix metalloproteinases （MMP）-1 ,-2,-3 and -9 in acute and chronic aortic diseases and acute myocardial ischemia. Methods The blood serum levels of MMP-1 ,-2,-3 and -9 were detected in 30 patients with acute aortic dissection, 19 patients with chronic aortic dissection, 19 patients with aortic aneurysm and in 12 patients with acute myocardial ischemia, as well as in 16 healthy individuals who served as the control group. Serum MMP levels were measured by using an ELISA technique. Results There were significantly higher levels of MMP-3 in patients with acute myocardial ischemia as compared to acute aortic dissection （ [ 19. 10 ± 3. 11 ] ug/L vs [ 11.89 ± 1.31 ] ug/L, P = 0.02）. Significantly lower levels of MMP-1 were found in healthy controls compared to the groups of patients （ [ 1. 30 ±0. 56 ] ug/L vs [ 2. 99 ± 0. 78 ] ug/L in acute aortic dissection, P = 0.03, [3.12 ±0.78] ug/L in chronic dissection,P =0.02, [3.01 ± 1.01 ] ug/L in thoracic aortic aneurysm,P =0.03 and [5.01 ± 0. 98 ] ug/L in acute myocardial ischemia, P = 0.01 ）. Higher levels of MMP-1 and MMP-3 were detected on males. There was a positive correlation between MMP-1 and increasing age （ r = 0. 38 ,P 〈 0.05）. In patients operated for acute type A aortic dissection, the levels of MMP-1, MMP-3 and MMP-9 increased immediately after surgery,while the levels of MMP-2 decreased. Twenty-four hours after surgery levels of MMP- 1 ,-2 and -9 were almost equal to the preoperative ones （P 〉 0. 05）. Conclusion Measurement of serum MMP levels in thoracic aortic disease and acute myocardial ischemia is a simple and relatively rapid laboratory test that could be used as a biochemical indicator of aortic disease or acute myocardial ischemia, when evaluated in combination with imaging techniques.