Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Chin Med J (Engl). 2011 Jun;124(11):1657-61.
Inflammation within vulnerable coronary plaques may cause unstable angina by promoting rupture and erosion. C-reactive protein (CRP) is the most reliable and accessible test method for clinical use for identifying coronary artery disease event. Matrix metalloproteinase 9 (MMP-9) is highly over-expressed in the vulnerable regions of a plaque. Our aim was to evaluate the plasma levels of MMP-9 and hsCRP in subjects with both unstable angina and coronary plaques, as well as in those with unstable angina without coronary plaques.
Patients with newly diagnosed unstable angina pectoris from clinical presentation and ECG, who were undergoing coronary angiography from April 2007 to April 2009, were included in this study. A total of 170 subjects were enrolled in the study. Before angiography, the baseline clinical data (mainly including conventional risk factors) was collected. These patients were divided into two groups, a non-plaque group (G1) which included 55 patients with no significant stenosis or less than 20% stenosis in at least one of the major coronary artery branches, and a plaque group (G2) which included 115 patients with at least one of the major coronary artery branches unstable angina pectoris with at least 50% stenosis of one major coronary artery. The patients presenting with calcified nodules of a major coronary artery were excluded from this study. We examined the serum levels of MMP-9 for all cases by multi-effect enzyme-linked immunosorbent assay.
There was a significant difference in the serum levels of MMP-9 between the two groups (P < 0.001). The percentage of patients with hypertension, diabetes and current smokers were significantly different between the two groups (P = 0.034, P = 0.031, and P = 0.044 respectively). The univariate Logistic regression analyses of risk factors showed that smoking was the main risk factor for angina in the non-plaque group with the OR being 1.95 (95%CI 1.02 - 3.75). Hypertension, diabetes mellitus were negatively related with the occurrence of angina in the non-plaque group with the ORs being 0.50, and 0.36, respectively (95%CI 0.26 - 0.96 and 0.14 - 0.94). The MMP-9 level was negatively related to the occurrence of angina in the non-plaque group with an OR of 0.59 (95%CI 0.47 - 0.81).
There is a significantly difference in MMP-9 levels between the plaque and non-plaque groups. Current smoking has a significant influence on unstable angina patients without documented plaques. The serum MMP-9 level may be a significant biomarker which can help differentiate patients with unstable angina with plaques from those with unstable angina but without plaques.
易损斑块内的炎症可能通过促进破裂和侵蚀导致不稳定型心绞痛。C 反应蛋白（CRP）是临床用于识别冠状动脉疾病事件的最可靠和最便捷的检测方法。基质金属蛋白酶 9（MMP-9）在斑块的易损区域高度过表达。我们的目的是评估患有不稳定型心绞痛和冠状动脉斑块的患者以及无冠状动脉斑块的不稳定型心绞痛患者的血浆 MMP-9 和 hsCRP 水平。
本研究纳入了 2007 年 4 月至 2009 年 4 月期间因临床症状和心电图表现而新诊断为不稳定型心绞痛的患者，他们正在接受冠状动脉造影检查。共有 170 名患者入组。在血管造影前，收集了基线临床数据（主要包括常规危险因素）。这些患者被分为两组：无斑块组（G1），包括 55 名至少一条主要冠状动脉分支无明显狭窄或狭窄程度<20%的患者；斑块组（G2），包括 115 名至少一条主要冠状动脉分支有不稳定型心绞痛且一条主要冠状动脉狭窄程度≥50%的患者。患有主要冠状动脉钙化结节的患者被排除在本研究之外。我们通过多效酶联免疫吸附试验检查了所有病例的 MMP-9 血清水平。
两组患者 MMP-9 血清水平差异有统计学意义（P<0.001）。两组患者高血压、糖尿病和当前吸烟者的比例差异有统计学意义（P=0.034、P=0.031 和 P=0.044）。危险因素的单因素 Logistic 回归分析显示，吸烟是无斑块组心绞痛的主要危险因素，OR 值为 1.95（95%CI 1.02-3.75）。高血压、糖尿病与无斑块组心绞痛的发生呈负相关，OR 值分别为 0.50 和 0.36（95%CI 0.26-0.96 和 0.14-0.94）。MMP-9 水平与无斑块组心绞痛的发生呈负相关，OR 值为 0.59（95%CI 0.47-0.81）。
斑块组和无斑块组 MMP-9 水平差异有统计学意义。当前吸烟对无斑块记录的不稳定型心绞痛患者有显著影响。血清 MMP-9 水平可能是区分有斑块和无斑块不稳定型心绞痛患者的一个重要生物标志物。
