Lorelli David R, Jean-Claude Jessie M, Fox Christopher J, Clyne Jason, Cambria Robert A, Seabrook Gary R, Towne Jonathan B
Division of Vascular Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
J Vasc Surg. 2002 May;35(5):916-22. doi: 10.1067/mva.2002.123676.
Matrix metalloproteinases are enzymes capable of breaking down all of the components of the extracellular matrix and have been implicated in the development of aneurysm formation. Because matrix metalloproteinase-9 (MMP-9) levels are elevated in aortic aneurysmal tissue and in that patient plasma, we hypothesized that plasma MMP-9 levels should decrease significantly after conventional and endovascular infrarenal abdominal aortic aneurysm (AAA) repair but that plasma MMP-9 levels would remain elevated in patients with endoleaks.
A sandwich enzyme-linked immunosorbent assay was used to measure plasma levels of MMP-9 in patients with AAA who underwent conventional (n = 26; mean age, 71.5 years) and endovascular (n = 25; mean age, 76.4 years) AAA repair. Levels were drawn before surgery and at 1 month and 3 months after surgery. Eight patients for endovascular repair had endoleaks identified on postoperative computed axial tomographic scans.
No correlation existed between preoperative plasma MMP-9 levels when compared with age, gender, or aneurysm diameter. No significant difference in preoperative plasma MMP-9 levels or AAA diameter was identified between patients with conventional repair compared with endovascular repair. Of the 51 patients, 33 had follow-up samples available for analysis. A significant increase in mean plasma MMP-9 levels was noted 1 month (149.5 +/- 40.1 ng/mL) after conventional AAA repair compared with preoperative levels (83.9 +/- 26.1 ng/mL; P <.05) and remained elevated 3 months after surgery (129.8 +/- 56.6 ng/mL). In those patients who underwent endovascular aneurysm exclusion without endoleak, a significant decrease in mean plasma MMP-9 levels was noted at 3 months (27.4 +/- 5.2 ng/mL) when compared with preoperative values (60.8 +/- 8.8 ng/mL; P <.01). In contrast, patients with endoleak after endovascular exclusion did not have a significant decrease in plasma MMP-9 levels at 3 months.
Plasma MMP-9 levels remain elevated for as much as 3 months after conventional AAA repair, whereas successful endovascular exclusion of an AAA results in decreased plasma MMP-9 levels by 3 months. MMP-9 may have clinical value as an enzymatic marker for endoleak after endovascular AAA exclusion.
基质金属蛋白酶是一类能够分解细胞外基质所有成分的酶，且与动脉瘤形成的发展有关。由于基质金属蛋白酶-9（MMP-9）在主动脉瘤组织及患者血浆中的水平升高，我们推测，在传统及血管腔内肾下腹主动脉瘤（AAA）修复术后，血浆MMP-9水平应显著降低，但在存在内漏的患者中，血浆MMP-9水平仍会升高。
采用夹心酶联免疫吸附测定法，测量接受传统（n = 26；平均年龄71.5岁）及血管腔内（n = 25；平均年龄76.4岁）AAA修复术的AAA患者血浆中的MMP-9水平。在手术前、术后1个月及3个月采集血样。接受血管腔内修复术的8例患者在术后计算机断层扫描中发现存在内漏。
术前血浆MMP-9水平与年龄、性别或动脉瘤直径之间无相关性。传统修复术患者与血管腔内修复术患者相比，术前血浆MMP-9水平或AAA直径无显著差异。51例患者中，33例有可供分析的随访样本。与术前水平（83.9±26.1 ng/mL）相比，传统AAA修复术后1个月（149.5±40.1 ng/mL）血浆MMP-9平均水平显著升高（P <.05），且术后3个月仍保持升高（129.8±56.6 ng/mL）。在那些接受血管腔内动脉瘤隔绝术且无内漏的患者中，与术前值（60.8±8.8 ng/mL）相比，术后3个月血浆MMP-9平均水平显著降低（27.4±5.2 ng/mL；P <.01）。相比之下，血管腔内隔绝术后存在内漏的患者在术后3个月血浆MMP-9水平未显著降低。
传统AAA修复术后长达3个月血浆MMP-9水平仍会升高，而成功的血管腔内AAA隔绝术可使血浆MMP-9水平在3个月时降低。MMP-9作为血管腔内AAA隔绝术后内漏的酶学标志物可能具有临床价值。
