基质金属蛋白酶-9和内皮素-1评价冠状动脉内支架术后再狭窄的意义

The significance of matrix metalloproteinase-9 and endothelin-1 in evaluating the in-stent restenosis after percutaneous coronary intervention procedure

目的探讨动态检测基质金属蛋白酶（MMP）-9、内皮素（ET）-1在经皮冠脉介人术（PCI）后再狭窄的意义。方法对30例经皮冠脉介人术后患者进行造影及光学相干断层成像（OCT）检查随访，造影证实再狭窄5例，共7处病变；无再狭窄25例，共34处病变。测量并比较两组内膜组织覆盖厚度、最狭窄处血管管腔面积、最狭窄处支架面积等，计算支架的最大内膜组织覆盖面积及支架的内膜组织覆盖面积百分比。术前及随访时均行MMP-9及ET-1检测，比较两组PCI前后MMP-9和ET-1的变化。结果与无再狭窄组比较，再狭窄组有更大的内膜组织覆盖厚度、内膜组织覆盖面积及更少的最小管腔面积。术前再狭窄组和非再狭窄组的MMP一9和ET—l浓度均无明显差异；术后再狭窄组的MMP一9、ET一1浓度明显高于非再狭窄组（P〈O．05）；术后再狭窄组MMP-9、ET-1浓度较术前明显升高（P〈0．05）；非再狭窄组术后MMP-9、ET-1浓度较术前均无明显变化。多因素Logistic回归分析显示，冠状动脉支架术后支架内再狭窄可能与MMP-9水平（P〈0．01，OR=1．84，95％CI：1．38-2．43）和ET-1水平（P〈0．0l，OR=1．37，95％CI：1．19~2．57）呈正相关。结论PCI后支架内再狭窄患者MMP-9和ET-1水平较术前升高。MMP-9及ET-1可作为预测冠脉再狭窄的参考指标。

Objective To discuss the relationship between the concentration of matrix metalloproteinase, endotheli-1 and the in-stent restenosis after percutaneous coronary .intervention procedure （PCI）. Methods PCI procedure was carried out in 30 patients with coronary artery disease in hospital. After the procedure, both coronary angiography and optical coherence tomography （OCT） were conducted during follow-up period. Base on the coronary angiography findings, in-stent restenosis （ISR） was confirmed in 5 cases with a total of 7 lesions （ISR group）, while no in-stent restenosis （non-ISR） was seen in 25 cases with a total of 34 lesions （non-ISR group）. The measurement indexes contain the maximal neointimal hyperplasia thickness of stent, minimal lumen cross-sectional area, steut cross-sectional area. And then the neointimal byperplasia area, the percentage of the area of the neointimal, diameter stenosis ratio were calculated before and after the treatment, and MMP-1 and ET-1 levels were determined. The changes in MMP-1 and ET-1 levels after PCI in each group were compared. Results Both the maximal neointimal hyperplasia thickness of stent and neointimal hyperplasia area were significantly larger, while the LA was significantly smaller, in ISR group than those in non-ISR group（P〈0.05）. Before PCI no significant differences in the concentration of MMP-1 and ET-1 were detected between the ISR and non-ISR groups. The concentration of MMP-9 and ET-1 in ISR group were obviously higher than that in non-ISR group （P〈0.05）. In ISR group, the concentration of MMP-9 and ET-1 before PCI were obviously increased than that after PCI （P〈 0.05 ）, while no obvious changes in MMP-9 and ET-1 level were found in non-ISR group. Multiple logistic stepwise regression analysis showed that there was a positive correlation among the levels of MMP-9 （P〈0.01, OR= 1.84, 95%CI：1.38-2.43） and ET-1 （P〈O.01, OR=1.37, 95%CI： 1.19-2.57） and ISR. Conclusion After PCI the increases of MMP-9 and ET-1 concentration bear a close relationship to the degree of restenosis.