摘要
目的:描述急性心肌梗死后血浆基质金属蛋白酶(MMP-2、MMP-9)的时间变化,及其与左室功能和左室重构的超声心动图参数之间的关系。方法和结果:对91例急性心肌梗死患者(ST段抬高与非抬高者分别为77例和24例;73%为男性;40%梗死部位为前壁)定期(0～12h、12～24h、24～48h、48～72h、72～96h、】96h)检测MMP-2、MMP-9;将172例年龄及性别相匹配的稳定性冠心病患者作为对照,单次检测M M P-2和MMP-9。
Aim: To describe temporal profiles of plasma matrix metalloproteinases(MMP-2 and MMP-9), and their relationship with echocardiographic(Echo) parameters of left ventricular(LV)function and remodelling, after acute myocardial infarction(AMI) in man. Methods and results: Plasma MMP-2 and MMP-9 were assayed at intervals(0- 12, 12- 24, 24- 48, 48- 72, 72- 96, and >96 h) in 91 patients with AMI(ST-elevation/non-ST-elevation 77/24; 73% male; 40% anterior site) and on a single occasion in 172 age- and sex-matched control subjects with stable coronary artery disease. Echo assessment of LV volumes, LV ejection fraction(LVEF), and wall motion index score were assessed before discharge and at follow-up(median 176, range 138- 262 days) for patients and on a single occassion in controls. Plasma MMP-2 was similar at all times after AMI, elevated when compared with control(P=0.005- 0.001) and unrelated to LV function or volume during index admission or at follow-up. Maximal MMP-9 was seen at 0- 12 h and was elevated when compared with control(P=0.002) followed by fall to a plateau. Both maximal and plateau MMP-9 concentration correlated with white blood cell(WBC, P=0.023 to< 0.001)and neutrophil count(P=0.014 to< 0.001). Maximal MMP-9 had independent predictive value for lower LVEF(P=0.004) during admission and for greater change in LV end-diastolic volume between admission and follow-up(R=0.3, P=0.016). In contrast, higher plateau levels of MMP-9 were associated with relative preservation of LV function(increasing LVEF, P=0.002; decreasing WMIS, P=0.009) and less change in end-systolic volume and end-diastolic volumes after discharge(P=0.001 and 0.024, respectively). Conclusion: Both MMP-9 and MMP-2 are elevated following AMI. The biphasic profile of plasma MMP-9 is related to LV remodelling and function following AMI in man. Higher early levels of MMP-9 associate with the extent of LV remodelling and circulating WBC levels. In contrast, higher plateau levels later after AMI are associated with relative preservation of LV function. Temporal profile, rather than absolute magnitude, of MMP-9 activity appears to be important for LV remodelling after AMI.
