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目的:探讨早期行冠状动脉介入治疗(PCI)的非ST段抬高型心肌梗死(NSTEMI)患者血浆中金属基质蛋白酶(MMPs)的时间变化规律及与心肌梗死(MI)后左心室重构的相关性。方法:成功随访12个月的早期行PCI的NSTEMI患者126例,于入院即刻、发病后2 d、4 d、2周、4周抽取外周静脉血,ELISA检测血浆中MMP-2和MMP-9的浓度。PCI术后患者临床随访12个月,对比入院时及术后12个月心脏超声图,分析左室舒张末期容积(LVEDV)和左室射血分数(LVEF)的变化及与MMPs的相关关系。结果:①MI后2周的时间内,血浆中MMP-2的浓度随着MI时间的延长而不断升高,其后MMP-2的浓度开始下降;MMP-9的浓度在MI后4 d时达到最高,其后MMP-9浓度开始明显下降。②同入院时相比,MI后12个月后LVEDV明显扩大,完成随访的患者LVEDV扩大(11±4)ml。LVEF明显降低,降低(9±3)%。MI后2 d时的MMP-9的浓度与ΔLVEDV呈正相关,与ΔLVEF的相关关系不明显。4 d时的MMP-9值与12个月后的ΔLVEDV和ΔLVEF呈正相关;MI后2周和4周MMP-2的浓度与12个月后的ΔLVEDV和ΔLVEF呈正相关。结论:NSTEMI患者MI后4 d的MMP-9和2周的MMP-2浓度与短期内左心室重构及左心室功能具有明显相关性。
Objective: To investigate the temporal variation of plasma matrix metalloproteinases (MMPs) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) who underwent coronary intervention (PCI) and the relationship between the changes of left ventricular remodeling Correlation. Methods: Totally 126 patients with early-stage NSTEMI who were followed up for 12 months were enrolled. Peripheral venous blood was drawn immediately after admission, 2 d, 4 d, 2 weeks and 4 weeks after the onset of PCI. The levels of MMP-2 and MMP-9 concentration. After PCI, the patients were followed up for 12 months. The changes of left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) and the correlation with MMPs were compared between two groups at admission and 12 months after operation. Results: ① After 2 weeks of MI, the concentration of MMP-2 in plasma increased with the increase of MI time, then the concentration of MMP-2 began to decrease; the concentration of MMP-9 reached at 4 d after MI Highest, then MMP-9 concentration began to decline significantly. ② LVEDV was significantly enlarged 12 months after MI compared with that at admission, and the LVEDV of patients who completed follow-up was (11 ± 4) ml. LVEF decreased significantly (9 ± 3)%. The concentration of MMP-9 at 2 d after MI was positively correlated with ΔLVEDV, but not with ΔLVEF. MMP-9 at 4 d was positively correlated with ΔLVEDV and ΔLVEF at 12 months. The levels of MMP-2 at 2 and 4 weeks after MI were positively correlated with ΔLVEDV and ΔLVEF after 12 months. Conclusions: The MMP-9 level at 4 d after MI and the MMP-2 level at 2 weeks in patients with NSTEMI are significantly correlated with left ventricular remodeling and left ventricular function in short term.