高敏C反应蛋白和基质金属蛋白酶-9及颈动脉斑块稳定性预测急性冠脉综合征心脏事件的价值

The Value of hs-CRP,MMP-9 and Carotid Plaque Stability in Predicting Cardiac Event of Patients with Acute Coronary Syndrome

目的探讨急性冠脉综合征(ACS)患者血高敏C反应蛋白(hs-CRP)、基质金属蛋白酶-9(MMP-9)水平及颈动脉斑块特征在心脏事件预测中的价值。方法测定143例ACS患者和42例健康对照者血清hsCRP、血浆MMP-9水平,经颈动脉超声评价颈动脉斑块特征,记录随访期内的心脏事件发生率。结果 AMI组hsCRP[(10. 97±4. 50)与(2. 54±0. 85) mg/L]、MMP-9[(98. 49±23. 84)与(60. 93±11. 50) ng/mL]水平均高于对照组(P <0. 05); UA组hs-CRP[(7. 09±3. 29)与(2. 54±0. 85) mg/L]、MMP-9[(89. 05±13. 32)与(60. 93±11. 50) ng/mL]均较对照组升高(P <0. 05); AMI组与UA组hs-CRP、MMP-9水平差异无统计学意义(P> 0. 05)。ACS患者斑块不稳定者较斑块稳定者hs-CRP[(14. 35±2. 28)与(7. 91±1. 92) mg/L]、MMP-9[(132. 92±20. 07)与(97. 95±14. 11) ng/mL]水平升高(P <0. 05)。ACS患者斑块稳定性与hs-CRP、MMP-9水平呈负相关性,相关系数分别为r=-0. 315(P <0. 05)和r=-0. 330(P <0. 05)。Logistic分析显示,hs-CRP(P <0. 05,OR=1. 106)、MMP-9(P <0. 05,OR=1. 025)、颈动脉斑块不稳定(P <0. 05,OR=12. 546)、TG(P <0. 05,OR=0. 300)、TC(P <0. 05,OR=4. 873)对心脏事件的发生有预测作用。结论 ACS患者hs-CRP和MMP-9水平升高及颈动脉斑块不稳定对心脏事件的发生有预测作用。

Objective To evaluate the role of high sensitive C-reactive protein( hs-CRP),matrix metalloproteinase-9( MMP-9) and carotid ultrasound in predicting cardiac event of patients with acute coronary syndrome( ACS). Methods The levels of hs-CRP and MMP-9 in 143 ACS subjects and 42 controls were measured,and the carotid ultrasounds were performed. Cardiac events were documented during a one-year follow-up. Results The levels of hs-CRP and MMP-9 in AMI group were increased,compared with the control group [( 10. 97 ± 4. 50) vs( 2. 54 ± 0. 85) mg/L,( 98. 49 ± 23. 84) vs( 60. 93 ± 11. 50) ng/ml],either P < 0. 05.Hs-CRP and MMP-9 levels in UA group were higher than that of control group [( 7. 09 ± 3. 29) vs( 2. 54 ± 0. 85) mg/L,( 89. 05 ±13. 32) vs( 60. 93 ± 11. 50) ng/ml],either P < 0. 05. No differences about hs-CRP and MMP-9 levels between AMI and UA groups,other P > 0. 05. Patients with unstable plaques had higher levels of hs-CRP [( 14. 35 ± 2. 28) mg/L〗 and MMP-9[( 132. 92 ± 20. 07) ng/ml]than that of stable plaque ones [( 7. 91 ± 1. 92) mg/L and( 97. 95 ± 14. 11) ng/ml],either P < 0. 05. The levels of hs-CRP and MMP-9 were negatively correlated with plaque stability( r =-0. 315,P < 0. 05). Multiple-factor logistic regression shown that hs-CRP( or = 1. 106,P < 0. 05),MMP-9( or = 1. 025,P < 0. 05),unstable plaque( or = 12. 546,P < 0. 05),total cholesterol( or = 4. 873,P < 0. 05) and triglyceride( or = 0. 300,P < 0. 05) might be regarded as predictors of cardiac event in patients with ACS. Conclusion Elevated Hs-CRP and MMP-9 levels,together with unstable carotid plaque play critical roles in predicting cardiac events of patients with ACS.