基质金属蛋白酶-9在ST段抬高性心肌梗死患者早期诊断及预后的价值

Values of matrix metalloproteinase-9 in early diagnosis and short-term prognosis of ST-segment elevation myocardial infarction

目的探讨血浆基质金属蛋白酶-9（MMP-9）对ST段抬高性心肌梗死（STEMI）患者的早期诊断价值，分析MMP-9与急性冠状动脉事件注册（GRACE）评分的关系及其对STEMI患者6个月发生主要不良心血管事件（MACE）的预测价值。方法连续入选2011年9月至2012年2月完全符合诊断标准的STEMI患者55例（早期STEMI者22例，后期STEMI者33例），冠状动脉造影正常的50例为对照组。用酶联免疫吸附试验（ELISA）检测血浆MMP-9水平，采用GFRACE评分标准计算STEMI患者GRACE积分并对其出院后随访6个月，观察终点为发生MACE的情况。结果早期STEMI组[1．81（0．22—2．33）mg／L]及后期STEMI组[1．91（0．47—2．21）mg／L]患者MMP-9水平均高于对照组[0．20（0．19～0．20）mg／L，P〈0．001]，MMP-9与入院GRACE评分呈正相关，住院期间发生MACE者8例，（14．5％）；随访6个月时，发生MACE17例（30．9％）。GRACE评分、血浆MMP-9水平在STEMI患者住院期间发生MACE的ROC曲线下面积（AUG）分别为0．848（95％C10．706—0．991．P=0．002）、0．766（95％C10．575—0．957，P=0．017），6个月内发生MACE的AUC分别为0．737（95％C10．601～0．873，P=0．005）、0．711（95％C10．565～0．856，P=0．013）。结论血浆MMP-9水平在早期STEMI的诊断具有较高价值，是STEMI患者近期发生MACE的预测因素。

Objective To evaluate the early diagnostic value of matrix metalloproteinase-9 （ MMP- 9） level on admission for ST-segment elevation myocardial infarction （STEMI）, explore the relationship between MMP-9 and global registry of acute coronary events （GRACE） scores and determine the values of MMP-9 in short-term prognosis of STEMI. Methods A total of 55 STEMI patients admitted into our hospital between September 2011 and February 2012 were recruited. There were early STEMI （ ~〈4h of onset, n = 22） and late STEMI （ 〉 4 h after onset, n = 33 ）. Fifty subjects of coronary artery without significant stenosis after angiography were enrolled into a control group. The plasma levels of MMP-9 in venous blood were detected with enzyme-linked immunosorbent assay （ELISA）. And the GRACE risk score was used for risk assessment. The incidence of new or recurrent myocardial infarction, target vessel revascularization, cardiac death, heart failure （MACE） was recorded during a follow-up period of 6 months. Results The MMP-9 levels were significantly higher in patients with STEMI （P 〈 0. 001 ）, early STEMI （P 〈 0. 001 ） and late STEMI （P 〈 0. 001 ） than the control group. And no statistical differences existed between early STEMI and late STEMI （ P 〉 0. 05 ）. The level of MMP-9 was positively correlated with the GRACE risk score. MACE occurred in 8 [ 14. 5% （8/55） ] patients during hospitalization and 17 [ 30. 9% （ 17/55 ） ] patients during follow-up. Receiver operating characteristic （ROC） curve analysis showed area under the curve （AUC） of on admission GRACE risk score and MMP-9 levels were 0. 848 （95% CI 0. 706 -0. 991, P =0. 002） and 0. 766 （95% CI 0. 575 - 0. 957, P = 0. 017 ） respectively. ROC curve analysis showed AUC of hospital discharge GRACE risk score and MMP-9 levels were 0. 737 （95% CI O. 601 -0. 873, P =0. 005） and 0. 711 （95% CI 0. 565 - 0. 856, P = 0. 013 ） respectively. No statistical differences existed between GRACE risk score and MMP-9 levels for predicting the short-term risk of MACE （ P 〉 0. 05 ）. Conclusion The plasma level of MMP-9 has a higher diagnostic value for early STEMI. Positively correlated with the GRACE risk score, it is a predicator of short-term risk of MACE.