Shirakabe Akihiro, Asai Kuniya, Hata Noritake, Yokoyama Shinya, Shinada Takuro, Kobayashi Nobuaki, Mizuno Kyoichi
Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical SchoolInzai, Chiba, Japan.
Int Heart J. 2010;51(6):404-10. doi: 10.1536/ihj.51.404.
The serum levels of matrix metalloproteinases (MMPs) increase during chronic heart failure (HF) and the MMP-2 are related to a poor prognosis. However, the roles of MMP-2 in acute HF (AHF) remain unclear. We investigated the change and clinical significance of MMP-2 in these conditions. The serum levels of MMP-2 were measured in 83 AHF patients before starting treatment (day 1), 3 (day 3) and 7 (day 7) days after admission, and before discharge (predischarge). MMP-2 decreased rapidly and significantly from day 3 to day 1 (902.9 ± 304.2 versus 1220.4 ± 330.5 ng/mL; P < 0.0001), whereas that of MMP-2 was not significantly different on day 7 and at predischarge (894.7 ± 278.9 and 920.0 ± 269.6 ng/mL, respectively) compared to day 3. We evaluated the relationships between ΔMMPs, defined as the changes in MMPs from day 1 to day 3 and HF events including cardiac death, readmission to hospital for HF, and uncontrollable HF. The MMP-2 value was significantly (P = 0.004) more decreased in the event-free group (381.4 ± 256.5 ng/mL) than in the event group (211.9 ± 225.5 ng/mL) between day 1 and day 3. The results of the multivariate logistic regression model for predicting HF events found that the specific factor for HF events was ΔMMP-2. Cutoff values of ΔMMP-2 were determined and event-free curves were constructed. Kaplan-Meier curves showed that the prognosis was significantly better among the patients with reductions in ΔMMP-2 values of more than 342 ng/mL. The serum levels of MMP-2 decreased with improvements in AHF. Rapid decreases in MMP-2 may be important for a better clinical outcome in patients with AHF.
慢性心力衰竭（HF）期间基质金属蛋白酶（MMPs）的血清水平会升高，且MMP - 2与不良预后相关。然而，MMP - 2在急性心力衰竭（AHF）中的作用仍不清楚。我们研究了MMP - 2在这些情况下的变化及其临床意义。在83例AHF患者开始治疗前（第1天）、入院后3天（第3天）、7天（第7天）及出院前（出院前）测定血清MMP - 2水平。MMP - 2从第3天到第1天迅速且显著下降（902.9±304.2对1220.4±330.5 ng/mL；P<0.0001），而与第3天相比，第7天和出院前MMP - 2水平无显著差异（分别为894.7±278.9和920.0±269.6 ng/mL）。我们评估了定义为从第1天到第3天MMPs变化的ΔMMPs与HF事件（包括心源性死亡、因HF再次入院和难以控制的HF）之间的关系。在第1天和第3天之间，无事件组（381.4±256.5 ng/mL）的MMP - 2值下降幅度显著大于事件组（211.9±225.5 ng/mL）（P = 0.004）。预测HF事件的多因素逻辑回归模型结果显示，HF事件的特定因素是ΔMMP - 2。确定了ΔMMP - 2的截断值并构建了无事件曲线。Kaplan - Meier曲线显示，ΔMMP - 2值降低超过342 ng/mL的患者预后明显更好。随着AHF病情改善，血清MMP - 2水平下降。MMP - 2的快速下降可能对AHF患者获得更好的临床结局很重要。
