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目的探讨基质金属蛋白酶9(MMP-9)对经皮冠状动脉介入治疗(PCI)不稳定型心绞痛(UAP)预后的预测作用。方法 136例UAP患者常规行PCI治疗,于术前1 d和术后1 d清晨分别抽取空腹血,酶联免疫吸附法检测MMP-9。系统随访6个月,记录重要心脏不良事件(MACE)的发生情况。结果 MMP-9浓度由术前1 d的(15.9±2.5)ng/mL下降为术后1 d的(10.9±2.3)ng/mL(t=17.165,P=0.000),平均MMP-9下降率为31.4%。随访半年内,发生MACE共19例(14.0%)。术后发生MACE患者的MMP-9浓度为(13.9±2.5)ng/mL,高于未发生MACE患者的MMP-9浓度(10.5±2.4)ng/mL(t=11.441,P=0.000)。MMP-9下降率对MACE发生预测的ROC曲线下面积为0.723,95%CI为0.624～0.754。下降率截断值为15%时,预测特异度为78.5%,灵敏度为82.1%。预后分析显示,MMP-9下降率≤15%的MACE发生率高于MMP-9下降率>15%患者(χ2=2.579,P=0.038)。Cox多因素调整后,其MACE发生OR为1.454。结论 MMP-9下降程度对不稳定型心绞痛介入治疗后的预后具有较好的预测作用。当MMP-9下降率在15%以内时,重要心脏不良事件的发生概率较高。
Objective To investigate the prognostic value of matrix metalloproteinase 9 (MMP-9) in the treatment of unstable angina pectoris (UAP) after percutaneous coronary intervention (PCI). Methods Thirty-six patients with UAP were routinely treated with PCI. Fasting blood was drawn on the first day before surgery and one day after the operation, and MMP-9 was detected by enzyme-linked immunosorbent assay. The system was followed up for 6 months to record the occurrence of major adverse cardiac events (MACE). Results The concentration of MMP-9 decreased from (15.9 ± 2.5) ng / mL on day 1 before operation to (10.9 ± 2.3) ng / mL on day 1 postoperatively (t = 17.165, P = 0.000) 31.4%. Within six months of follow-up, MACE occurred in 19 cases (14.0%). The MACE level in postoperative MACE patients was (13.9 ± 2.5) ng / mL, higher than that of patients without MACE (10.5 ± 2.4) ng / mL (t = 11.441, P = 0.000). The area under the ROC curve predicted by the decline of MMP-9 on MACE was 0.723, and the 95% CI was 0.624-0.754. When the rate of descent was 15%, the predicted specificity was 78.5% and the sensitivity was 82.1%. Prognostic analysis showed that the incidence of MACE with a decline rate of MMP-9 ≤15% was higher than that with a decline rate of MMP-9> 15% (χ2 = 2.579, P = 0.038). After Cox multivariate adjustment, the OR of MACE was 1.454. Conclusion The decrease of MMP-9 may predict the prognosis of patients with unstable angina after interventional therapy. When the rate of decline of MMP-9 is less than 15%, the incidence of major cardiac adverse events is higher.