基质金属蛋白酶9与急性A型主动脉夹层患者长期预后的相关性

Association between MMP-9and long-term outcome in patients with type A acute aortic dissection

目的探讨血浆基质金属蛋白酶9（MMP-9）与急性A型主动脉夹层患者长期预后的关系。方法连续入选A型主动脉夹层患者97例,分为死亡组66例和存活组31例。采用ELISA检测入院时血浆MMP-9。以随访期间死亡作为随访终点。采用ROC曲线和Cox生存回归分析MMP-9对患者死亡的预测价值。结果平均随访417d,与存活组比较,死亡组患者入院时MMP-9明显升高[（2.13±0.62）mg/L vs（1.68±0.55）mg/L,P=0.000]。ROC曲线分析提示,MMP-9对急性A型主动脉夹层患者死亡具有预测价值（曲线下面积为0.899,95%CI：0.84～0.94,P〈0.01）。Kaplan-Meier生存分析显示,在药物治疗和手术治疗患者中,MMP-9高值患者累计生存率分别低于MMP-9低值患者（P〈0.01）。Cox生存回归分析显示,MMP-9≥2.09mg/L分别为药物治疗（HR=3.39,95%CI：1.84～7.43,P=0.000）和手术治疗（HR=3.12,95%CI：1.78～9.64,P=0.000）死亡的独立危险因素之一。结论 MMP-9与急性A型主动脉夹层患者预后相关,MMP-9≥2.09mg/L为其长期死亡的独立危险因素,并能够区分高危患者。

Objective To study the association between MMP-9and long-term outcome in patients with type A acute aortic dissection（AD）.Methods Ninety-seven patients with type A acute AD were divided into dead group（n=66）and survival group（31）.Their serum MMP-9levels were measured by ELISA at admission.Death occurred in follow-up period was used as the follow-up endpoint.The predictive value of MMP-9for death in patients with type A acute AD was analyzed by ROC curve analysis and Cox hazard ratio regression analysis,respectively.Results The mean follow-up time of patients was 417 days.The serum MMP-9level was significantly higher in dead group than in survival group（2.13±0.62 mg/L vs 1.68±0.55 mg/L,P=0.000）.ROC curve analysis showed that MMP-9could predict the death of patients with type A acute AD（the area under ROC curve=0.899,95%CI：0.84-0.94,P〈0.01）.Kaplan-Meier survival analysis revealed that the survival rate was lower in patients with a high MMP-9value than in those with a low MMP-9value after drug treatment and operation（P〈0.01）.Cox survival analysis displayed that MMP-9≥2.09mg/L was a risk factor for death in patients with type A acute AD after drug treatment and operation（HR=3.39,95%CI：1.84-7.43,P=0.000;HR=3.12,95%CI：1.78-9.64,P=0.000）.Conclusion MMP-9is closely associated with the long-term outcome in patients with type A acute AD.MMP-9≥2.09mg/L is a risk factor for death in such patients and can identify high risk patients.