同型半胱氨酸和基质金属蛋白酶9与冠心病的相关性研究

Correlation of homocysteine,matrix metalloproteinase-9 with coronary heart disease

目的通过观察不同类型冠心病(coronary heart disease,CHD)患者血浆高敏C反应蛋白(high sensitivity C-reactive protein,hsCRP)、同型半胱氨酸(homocysteine,HCY)及基质金属蛋白酶9(matrix metalloproteinases-9,MMP-9)的水平变化,探讨hsCRP、HCY和MMP-9与CHD的发生发展及与动脉粥样硬化斑块稳定性的相关性。方法选取我院心内科因胸痛症状入院且入院后行冠状动脉造影术的患者267例,其中CHD组202例,对照组(冠状动脉造影正常者)65例,CHD组又分为急性心肌梗死组(AMI)68例,不稳定型心绞痛组(UA)81例,稳定型心绞痛组(SA)53例。采用双抗体夹心酶联免疫吸附测定法(ELISA)检查血浆MMP-9的水平,hsCRP、HCY由检验科用免疫散射比浊法检测。结果①CHD组hsCRP、HCY、MMP-9水平均高于对照组(P<0.01)。②AMI组、UA组患者血浆hsCRP、HCY和MMP-9水平均显著高于对照组及SA组(P<0.05)。③AMI组与UA组hsCRP水平及HCY水平差异无统计学意义。④AMI组MMP-9水平显著高于UA组(P<0.01)。⑤CHD患者血浆hsCRP分别与HCY、MMP-9呈正相关(r=0.128、0.199,P<0.05),HCY和MMP-9之间亦成正相关(r=0.400,P<0.05)。⑥Logistic逐步回归分析显示:年龄、高血压史、总胆固醇、高密度脂蛋白胆固醇、吸烟、hsCRP、MMP-9、HCY是冠心病的独立影响因素,且HCY、MMP-9及吸烟是急性冠状动脉综合征患者的独立相关因子。结论①hsCRP、HCY、MMP-9水平升高是CHD的独立危险因素;②急性冠状动脉综合征患者(AMI组和UA组)hsCRP、HCY、MMP-9水平升高可能提示动脉粥样硬化斑块的不稳定性。

Objective To observe high sensitivity C-reactive protein（hsCRP）,homocysteine（HCY） and matrix metalloproteinases-9（MMP-9） in different types of coronary heart disease（CHD）,to explore the relationship between these markers and the instability of atherosclerotic plaques.Methods The study selected 267 cases of patients admitted to hospital because of chest pain symptoms and with coronary artery angiography,68 cases of acute myocardial infarction（AMI）,unstable angina（UA） of 81 cases and stable angina（SA） 53 cases,65 cases of control group （normal coronary angiography）.Enzyme linked immunosorbent assay was used to determine plasma MMP-9 level,hsCRP and HCY levels were detected by immune scattering turbidimetric method.Results were positively correlated with each other age,history of hypertension,smoking,total cholesterol low density lipoprotein cholesterol,hsCRP,HCY,MMP-9 were independent risk factors for CHD,and HCY,MMP-9,smoking were independent risk factors for acute coronary syndrome.Conclusion Elevated hsCRP,HCY,MMP-9 levels were independent risk factors for CHD.Higher HCY,MMP-9 levels in acute coronary syndrome patients（including AMI group and UA group） may indicate the instability of atherosclerotic plaques.