MMP-9与急性STEMI患者介入治疗近期ISR的关联性研究

The relationship between MMP-9 and the recent incidence of ISR of the acute STEMI patients who received PCI treatment

目的 观察基质金属蛋白酶-9（MMP-9）与急性ST段抬高心肌梗死（STEMI）接受经皮冠状动脉介入（PCI）治疗并置入药物涂层支架的患者近期支架内再狭窄（ISR）的关系。方法 选择2010年3月至2013年3月在该院接受介入治疗的STEMI患者210例为观察对象,按照是否发生ISR,分为ISR组33例与无ISR组177例,测量并比较两组外弹力膜横截面面积、斑块面积、最小管腔面积及内膜增生面积;术前及随访时均检测MMP-9水平。结果 ISR组患者MMP-9水平在随访节点明显高于非ISR组,ROC曲线分析发现,以MMP-9≥2.425ng/mL为诊断分界值预测ISR的发生,其曲线下面积（AUC）为0.834（95%CI：0.745~0.923）,敏感度0.697,特异性0.915,约登指数0.612,具有较好的诊断价值。MMP-9升高的患者外弹力膜横截面积、内膜增生面积及斑块面积大于不升高患者,而最小管腔面积低于不升高患者,差异有统计学意义（P〈0.05）。结论 PCI术后ISR患者MMP-9水平较术前升高,监测MMP-9水平对PCI术后ISR有一定的预测作用。

Objective To observe the relationship between MMP-9 and the recent incidence of ISR of the acute STEMI patients who received PCI treatment and drug-eluting stents. Methods From March 2010 to March 2013,210 STEMI patients who received PCI treatment were collected,according to the occurrence of ISR whether or not, these patients were divided into ISR group （33 cases）and non-ISR group（177 cases）. Before the treatment and after the six-mouth（or the occurrence of ISR）, the external elas- tic membrane cross-sectional area, plaque area, minimum lumen area, intimal hyperplasia area and serumal level of MMP-9 were measured and compared. Results Six-mouth after PCI（or at the occurrence of ISR） ,serumal level of MMP-9 of ISR group patients were higher than before PCI treatment,and also higher than non-ISR group. ROC curve analysis found that take MMP-9≥2. 425 ng/mL as cut-off value to predict the occurrence of ISR, the area under the curve（AUC）was 0. 834（95 %CI：0. 745 to 0. 923）, the sensitivity was 0. 697,specificity was 0. 915, Youden index was 0. 612,it was provided with better diagnostic value. Patients with higher serumal level of MMP-9 also had a higher level of external elastic membrane cross-sectional area, plaque area and intimal hyperplasia area,a lower level of minimum lumen area, compared with the patients with lower serumal level of MMP-9 （P〈0.05）. Conclusion The level of MMP-9 in patients with ISR after PCI was higher than that before operation, monitoring the level of MMP-9 had a certain predictive effect on ISR after PCI.