后循环缺血患者椎动脉开口支架置入术后基质金属蛋白酶变化对再狭窄的影响

Effects of matrix metalloproteinase on post-stenting restenosis in paitents with posterior circulation ischemia

目的：探讨后循环缺血患者椎动脉开口支架置入术后基质金属蛋白酶9（MMP．9）及基质金属蛋白组织抑制剂1（TIMP-1）的水平变化、二者相互关系及其对术后再狭窄的影响。方法：入选158例后循环缺血患者为治疗组．于支架置入术前、术后即刻、术后第3天抽取静脉血标本检测MMP-9与TIMP-1水平。随访3～9个月，其中共68例患者行全脑血管造影术，根据全脑DSA结果分为再狭窄患者15例，未狭窄患者53例，另选同时期全脑DSA术结果正常者40例为对照组。结果：与对照组比较．治疗组术前MMP-9升高（P〈0．01），MMP-9／TIMP-1高于对照组（P〈0．05），而TIMP-1差异无统计学意义（P〉0．05）；治疗组术前、术后即刻、术后第3天MMP-9、TIMP-1呈逐渐增高趋势，二者呈正相关；与未狭窄组比较，再狭窄组术后及随访时MMP-9和MMP-9／TIMP-1均明显升高（P〈0．01），而TIMP-1差异无显著性。结论：MMP-9升高可能参与支架置入术后再狭窄的病理生理过程，并对术后再狭窄的发生可能有预测价值，而MMP-9与TIMP-1变化有一定相关性．呈正相关。

Objective To explore the changes of serum levels of metallortcinase-9 （MMP-9） and tissue inhibitors of metalloproteinase-1 （TIMP-1） and their effects on post-stenting restenosis in patients with posterior circulation ischemia （PCI）. Methods The serum levels of MMP-9 and TIMP-1 in 158 patients with PCI （treatment group） before stenting, right after stenting and 3 d after stenting were detected. After 3-9 months of follow-up, 68 patients were divided into restenosis group （n = 15） and non-restenosis group （n = 53） according to the results from cerebral angiography. 40 controls with normal cerebral arteries indicated by DSA were included as control group. Results As compared to those in control group, serum levels of MMP-9 and MMP-9/TIMP- 1 in treatment group were higher before stenting （P 〈 0.05）. Serum levels of MMP-9 and TIMP-1 were increased gradually after stenting, and both of them were positively correlated with each other. Serum levels of MMP-9 and MMP-9/TIMP-1 were higher in restenosis group （P 〈 0.01 ） than those in non-restenosis group. Conclusion MMP-9 may contribute to the pathophysiological process of post-stenting restenosis and may be a predictive factor for post-stenting restenosis. There is positive correlation between TIMP-1 and MMP-9.