肱动脉-踝动脉脉搏波传导速度以及同型半胱氨酸和基质金属蛋白酶-9与冠心病危险程度的相关性

Study on the relationship among brachial-ankle pulse wave velocity, serum homocysteine, serum matrixmetallopro teinases-9 and coronary heart disease

目的探讨肱动脉·踝动脉脉搏波传导速度（baPWV）、同型半胱氨酸（Hey）和基质金属蛋白酶-9（MMP-9）与冠状动脉粥样硬化性心脏病（以下称冠心病）的关系。方法选择2009年6月至2011年3月宁夏医科大学第二附属医院心内科住院，依据冠状动脉造影显示主要冠状动脉（左主干、左前降支、左旋支、右冠状动脉）中任何一支内径狭窄t〉50％，诊断为冠心病的患者66例（冠心病组），并选取同期健康体检者40名作为对照组。又将66例冠心病患者根据冠状动脉造影示冠状动脉病变支数不同分为1支病变组18例，2支病变组25例和多支病变组23例。测定各组的baPWV以及Hcy和MMP．9浓度，比较各组间的差异及其相互关系。结果冠心病组baPWV[（2132±240）cm／s]、Hcy[（14．32±5．20）μmol／L]、MMP-9[（768．0±95．3）μg/L]高于对照组[（1360±81）cm／s、（6．50±1．40）μmol／L、（228．0±56．2）μg／L]，两组比较差异有统计学意义（t值分别为23．97、11．54、36．69，P均〈0．01）。冠心病患者多支病变组的baPWV[（2041±168）cm／s]、Hcy[（21．31±6．30）μmol／L]、MMP-9[（1042．0±180．2）μg／L]均高于1支病变组[（1560±172）cm／s、（10．50±3．20）μmol／L、（723．0±102．2）μg/L]和2支病变组[（1873±150）cm／s、（15．32±5．80）μmol／L、（940．0±175．8）μg/L]，3组间比较差异有统计学意义（F值分别为45．36、36．18、41．06，P均〈0．01）；其中2支病变组又高于1支病变组，差异有统计学意义（P均〈0．05）。冠心病组Hey与baPWV呈正相关（r=0．475，P〈0．05）；MMP-9与baPWV呈正相关（r=0．630，P〈0．01）；Hey与MNP-9呈正相关（r=0．351，P〈0．05）。结论baPWV、Hcy和MMP-9与冠心病患者冠状动脉病变程度有关，三者联合检测可用来评估冠心病的危险程度。

Objective To investigate relationship among Brachial-ankle pulse Wave Velocity （baPWV）, Homocysteine （Hcy）, Serum Matrix Metallopro Teinases-9 （MMP-9） and coronary heart disease. Methods Sixty-six cases of patients diagnosed as coronary heart disease according to the coronary angiography showed any one of the main coronary arteries （left main, left anterior descending, left circumflex artery,fight coronary artery） diameter stenosis≥ 50% were selected into coronary heart disease from June 2009 to March 2011 hospitalized in the Second Affiliated Hospital of Ningxia Medical Cardiology. And 40 cases of healthy people who had medical examination over the same period were selected into the normal control group. The 66 cases of patients were further divided into single-branch-affected group （n = 18 ）, two-branch- affected group（ n = 25 ） and multi-branch-affected group（ n = 23 ） according to the branches of coronary artery pathological changes shown in coronary angiography. Detected and compared baPWV, Hcy and MMP-9 among these groups. Results The baPWV, Hcy and MMP-9 in coronary heart disease group were significantly higher than those in the control group （ baPWV ： （ 2132± 240 ） cm/s vs （ 1360 ±81 ） cm/s, t = 23.97, P 〈 0. 01 ; Hcy ： （14.32±5.20） μmol/L vs （6.50 ±1.40） μmol/L,t = 11.54,P 〈 0.01;MMP-9：（768.0 ±95.3） μg/L vs （228.0 ±56. 2） μg/L,t =36. 69 ,P 〈0. 01 ） ;The baPWV,Hcy and MMP-9 in multi-branch-affected group were significantly higher than those in single-branch-affected and two-branch-affected group ; The baPWV, Hcy and MMP-9 in two-branch-affected group were higher than those in single-branch-affected group（ baPWV （2041±168） em/s vs （ 1873 ± 150） cm/s vs （ 1560±172） cm/s,F =45.36 ,P 〈0. 01 ;Hcy： （21.31±6. 30） Ixmol/Lvs （ 15.32± 5.80） μmol/L vs （ 10. 50± 3.20） μmol/L, F = 36. 18, P 〈 0. 01 ; MMP-9 ： （ 1042. 0 ± 180. 2 ） μg/L vs （940.0± 175.8） μg/L vs （723.0 ± 102.2） μg/L,F =41.06, P 〈0.01）.The serum MMP-9 was significantly positive correlated with baPWV and Hey （r =0. 630 ,P 〈0.01 ;r =0. 351 ,P 〈0. 05） ;The Hey was significantly positive correlated with baPWV （r = 0. 475, P 〈 0.05 ） in the coronary heart disease group. Conclusion The baPWV, Hcy and MMP-9 were related with the degree of artery stenosis in coronary heart disease. Combined detection of these three markers can be used to assess the risk of coronary heart disease.