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目的:探讨不同分级妊娠合并心脏病患者血清组织抑制物1(TMP-1)及血清基质金蛋白酶1(MMP-1)的水平变化及其与左心室结构及功能的相关性。方法:根据美国纽约心脏病协会(NYHA)分级标准将74例妊娠合并心脏病患者分为Ⅰ级18例,Ⅱ级22例,Ⅲ级16例,Ⅳ级18例,另选取同期行常规检查的正常妊娠妇女20例为对照组,采用ELISA免疫法测定各组血清MMP-1及TIMP-1水平,同时采用多普勒超声心动仪测定各组左心室结构及功能。结果:①各组血清MMP-1及TIMP-1水平:Ⅳ级患者血清MMP-1及TIMP-1水平显著高于Ⅰ级、Ⅱ级、Ⅲ级及对照组,两两比较差异有统计学意义(P<0.05)。②左心室结构及功能:妊娠合并心脏病患者LVMI、LVEDd、A峰显著高于对照组,而EF、E峰、E/A比值则低于对照组,差异有统计学意义(P<0.05)。③妊娠合并心脏病组SVTI、SFF、AR、S/D显著高于对照组,而DVTI、DFF低于对照组,两两比较差异有统计学意义(P<0.05)。④相关性:MMP-1水平与LVMI、LVEDd呈正相关(P<0.05),与EF呈负相关(P<0.05),而TIMP-1与LVMI、LVEDd、E峰呈正相关(P<0.05)。结论:妊娠合并心脏病孕妇血清MMP-1及TIMP-1水平显著上升,并且随着患者心脏功能加重而显著升高,并与患者心室功能及结构的严重程度有密切关系。
Objective: To investigate the changes of serum levels of tissue inhibitor of metalloproteinase-1 (TMP-1) and serum matrix metalloproteinase-1 (MMP-1) and their relationship with left ventricular structure and function in patients with different grading of pregnancy complicated with heart disease. Methods: According to the New York Heart Association (NYHA) grading standards, 74 cases of pregnancy complicated with heart disease were divided into Ⅰ grade in 18 cases, Ⅱ grade in 22 cases, Ⅲ grade in 16 cases and Ⅳ grade in 18 cases. Twenty normal pregnant women were used as the control group. Serum levels of MMP-1 and TIMP-1 were measured by ELISA. The left ventricular structure and function of each group were measured by Doppler echocardiography. Results: ① The serum levels of MMP-1 and TIMP-1 in each group: The levels of serum MMP-1 and TIMP-1 in grade Ⅳ patients were significantly higher than those in grade Ⅰ, Ⅱ, Ⅲ and control group, with statistically significant differences (P <0.05). ② Left ventricular structure and function: LVMI, LVEDd and A peak in pregnancy complicated with heart disease were significantly higher than those in control group, and EF, E peak and E / A ratio were lower than those in control group (P <0.05) . ③ The SVTI, SFF, AR, S / D in pregnancy complicated with heart disease were significantly higher than those in control group, while the DVTI and DFF were lower than those in control group. There was significant difference between every two groups (P <0.05). ④ Correlation: The level of MMP-1 was positively correlated with LVMI and LVEDd (P <0.05), negatively correlated with EF (P <0.05), while TIMP-1 was positively correlated with LVMI, LVEDd and E (P <0.05). Conclusion: The levels of serum MMP-1 and TIMP-1 in pregnant women with heart disease complicated with heart disease significantly increase, and are significantly increased with the increase of cardiac function in pregnant women with pregnancy, and are closely related to the severity of ventricular function and structure.