冠状动脉血清纤维蛋白原、基质金属蛋白酶-9及白细胞介素-6在ST段抬高型急性心肌梗死患者中的表达及预后研究

Expression of coronary serum fibrinogen, matrix metalloproteinase-9 and interleukin-6 in patients with ST-segment elevation acute myocardial infarction and their relationship with prognosis

目的 分析冠状动脉血清纤维蛋白原、基质金属蛋白酶-9及白细胞介素-6在ST段抬高型急性心肌梗死患者中的表达及与预后的关系。方法 选取2017年10月~2020年10月在本院心内科因STEMI行PCI术治疗的152例患者作为研究对象,另收集我院不稳定型心绞痛(UAP)组152例,稳定型心绞痛(SAP)组152例;选择同期住院的80例非冠状动脉粥样硬化性心脏病患者作为对照组。1年后随访,根据患者是否发生MACE分为MACE组和非MACE组。检测Fib、MMP-9、IL-6相关性,ROC曲线检测Fib、MMP-9、IL-6对STEMI患者的诊断价值,Cox分析相关性。结果 各组患者年龄、吸烟史、高血压、糖尿病、高脂血症、脑卒中、饮酒史及舒张压均无统计学差异(P>0.05)。与对照组相比,STEMI组、UAP组、SAP组患者血清Fib、MMP-9、IL-6水平升高(P<0.05),与STEMI组相比,UAP组、SAP组患者血清Fib、MMP-9、IL-6水平降低(P<0.05),UAP组、SAP组患者血清Fib、MMP-9、IL-6水平对比无意义(P>0.05)。根据患者是否发生MACE分为MACE组和非MACE组,1年随访后患者发生MACE的为50例(32.89%)、未发生MACE的为102例(67.11%)。Fib指标ROC曲线面积为0.788,灵敏度为91.31%、特异度为80.54%,MMP-9指标ROC曲线面积为0.769,灵敏度为89.64%、特异度为77.25%,IL-6指标ROC曲线面积为0.754,灵敏度为68.724%%、特异度为71.35%,说明Fib、MMP-9、IL-6对STEMI具有较高的诊断效能。对MACE组与非MACE组患者进行COX风险因素分析,结果显示Fib、MMP-9、IL-6是影响STEMI患者预后的相关危险因素。Fib与MMP-9呈正相关,相关系数为0.625(P<0.05);Fib与IL-6呈正相关,相关系数为0.437(P<0.05);MMP-9与IL-6呈正相关,相关系数为0.516(P<0.05)。结论 MMP-9、Fib、IL-6水平升高可能促进冠心病患者血管内皮损伤,导致PCI术后血栓形成,与患者MACE的发生密切相关。对于行PCI术的患者,及时检测其血清中MMP-9、Fib、IL-6水平有助于监测患者病情,值得临床关注。

Objective To investigate the expression of Fib, MMP-9 and IL-6 in STEMI and analyze its correlation with prognosis.Methods A total of 152 patients who underwent PCI for STEMI in the department of Cardiology of our hospital from October 2017 to October 2020 were selected as the study subjects. In addition, 152 patients in the UAP group and 152 patients in the SAP group were collected. Eighty patients with non-atherosclerotic heart disease who were hospitalized at the same time were selected as the control group. After 1-year follow-up, patients were divided into MACE group and non-MACE group according to the absence of MACE. The correlation among Fib, MMP-9 and IL-6 was analyzed. The diagnostic value of Fib, MMP-9 and IL-6 in STEMI patients was detected by ROC curve, and the correlation was analyzed by Cox. Results Age, smoking history, hypertension, diabetes, hyperlipidemia, stroke, drinking history and diastolic blood pressure were all insignificant in each group(P>0.05), while sex and systolic blood pressure were significant(P<0.05). Compared with the control group, the levels of Fib, MMP-9 and IL-6 in STEMI group, UAP group and SAP group were increased(P<0.05), and the levels of Fib, MMP-9 and IL-6 in UAP group and SAP group were decreased(P<0.05). Serum Fib, MMP-9 and IL-6 levels in UAP group and SAP group had no significant difference(P>0.05). According to the occurrence of MACE, the patients were divided into MACE group and non-MACE group. After 1-year follow-up, 50 patients(32.89%) developed MACE and 102 patients(67.11%) did not. The ROC curve area of Fib index was 0.788, with a sensitivity of 91.31% and specificity of 80.54%. The ROC curve area of MMP-9 index was 0.769, with a sensitivity of 89.64% and specificity of 77.25%;the ROC curve area of IL-6 index was 0.754. The sensitivity and specificity were 68.724%% and 71.35%, indicating that Fib, MMP-9 and IL-6 had high diagnostic efficacy for STEMI. COX risk factor analysis of MACE group and non-MACE group showed that Fib, MMP-9 and IL-6 were related risk factors affecting the prognosis of STEMI patients. Fib was positively correlated with MMP-9, and the correlation coefficient was 0.625(P<0.05). Fib was positively correlated with IL-6, and the correlation coefficient was 0.437(P<0.05). Mmp-9 was positively correlated with IL-6, and the correlation coefficient was 0.516(P<0.05). Conclusions Increased levels of MMP-9, Fib and IL-6 may promote vascular endothelial injury in patients with coronary heart disease, leading to thrombosis after PCI, which is closely related to the occurrence of MACE in patients. For patients undergoing PCI, timely detection of serum LEVELS of MMP-9, Fib and IL-6 is helpful to monitor the patient’s condition, which is worthy of clinical attention.