急性冠脉综合征患者MIF MMP-1表达及PCI术后动态变化

Expression of MIF and MMP-9 in acute coronary syndrome and dynamic change after PCI

目的探讨巨噬细胞移动抑制因子(MIF)和基质金属蛋白酶-1(MMP-1)在急性冠脉综合征患者血清中的表达及经皮冠状动脉介入治疗(PCI)术后动态变化。方法将120例临床诊断并经冠脉造影(CAG)证实的冠心病患者分为SAP组40例、UAP组42例和AMI组38例,另外选择CAG结果正常的30例为正常对照组。所有患者均于入院次日清晨空腹抽取静脉血5 mL,UAP组和AMI组行PCI术治疗的患者还分别于术后6 h,1,2,3,7,14,21,28 d取血,采用酶联免疫吸附法(ELISA)分别检测血清MIF、MMP-1水平。结果AMI组、UAP组血清MIF、MMP-1水平均显著高于SAP组及对照组(P<0.05);不同冠脉病变支数之间血清MIF、MMP-1水平比较差异均无显著性(P>0.05);不同冠脉狭窄程度之间血清MIF、MMP-1水平比较差异均无显著性(P>0.05);PCI术后MIF、MMP-1表达水平较术前明显增高:MIF术后2 d达到高峰,然后缓慢下降,28 d恢复术前水平。MMP-1术后1 d达到高峰,然后缓慢下降,21 d恢复术前水平。结论血清MIF、MMP-1水平与冠脉斑块不稳定性有关,而与冠脉狭窄程度无关,可作为ACS发病的重要预测因子;PCI术可能加重了术后冠脉内早期炎症反应,而MIF、MMP-1参与了这一过程,针对MIF、MMP-1的靶向治疗可能减少PCI术后并发症的发生。

Objective To explore expression of serum levels of macrophage migration inhibitory factor（MIF） and matrix metalloproteinase-9（MMP-1） and dynamic change after PCI in acute coronary syndrome（ACS）.Methods 120 patients with coronary heart disease were selected according to the results of coronary angiography and clinical manifestation.They were divided into three groups：SAP group（n=40）,UAP group（n=42） and AMI group（n=38）.30 patients with negative CAG results were selected as normal control group.The blood samples with 5 mL were drown from venous in morning of the following day after hospitalization.In addition,the blood samples were drown from venous of patients undergoing PCI operation on 6h,1d,2d,3d,7d,14d,21d and 28d after PCI.The serum levels of MIF and MMP-9 were delected by enzyme-linked immunosorbent assay（ELISA）.Results The concentrations of MIF and MMP-1 in AMI group and UAP group were significantly higher than those in SAP and control group（P0.05）.Neither MIF nor MMP-1 was statistical difference among one-vessel,two-vessel and three-vessel group（P0.05）.Neither MIF nor MMP-1 was statistical difference among mild,middle and serious stenosis group in patients with ACS（P0.05）.MIF and MMP-1 expression level were increased sharply after PCI.The MIF expression achieve peak level in 2 days,then decrease slowly and revived preoperative levels in 28 days.MMP-1 expression achieved peak level at day 1,then slowed drop and decreased slowly,it revived preoperative levels at day 21.Conclusion Serum MIF and MMP-9 levels are related to the unstability of coronary artery plaque and no relation with the degree of coronary artery stenosis,which may be important in prediction of ACS.PCI technology aggravate the early intravascular inflammation after postoperative.MIF,MMP-1 involved in this process,MIF,MMP-1 targeted therapy may reduce the incidence of complications after PCI.