血清 MMP-8：急性心肌梗死后患者左心室重构和心脏结局的新指标。
Serum MMP-8: a novel indicator of left ventricular remodeling and cardiac outcome in patients after acute myocardial infarction.
机构信息
Centre Hospitalier Régional et Universitaire de Lille, Lille, France.
出版信息
PLoS One. 2013 Aug 14;8(8):e71280. doi: 10.1371/journal.pone.0071280. eCollection 2013.
OBJECTIVE
Left ventricular (LV) remodeling following myocardial infarction (MI) is characterized by progressive alterations of structure and function, named LV remodeling. Although several risk factors such as infarct size have been identified, LV remodeling remains difficult to predict in clinical practice. Changes within the extracellular matrix, involving matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), are an integral part of left ventricular (LV) remodeling after myocardial infarction (MI). We investigated the temporal profile of circulating MMPs and TIMPs and their relations with LV remodeling at 1 year and clinical outcome at 3 years in post-MI patients.
METHODS
This prospective multicentre study included 246 patients with a first anterior MI. Serial echocardiographic studies were performed at hospital discharge, 3 months, and 1 year after MI, and analysed at a core laboratory. LV remodeling was defined as the percent change in LV end-diastolic volume (EDV) from baseline to 1 year. Serum samples were obtained at hospital discharge, 1, 3, and 12 months. Multiplex technology was used for analysis of MMP-1, -2, -3, -8, -9, -13, and TIMP-1, -2, -3, -4 serum levels.
RESULTS
Baseline levels of MMP-8 and MMP-9 were positively associated with changes in LVEDV (P = 0.01 and 0.02, respectively). When adjusted for major baseline characteristics, MMP-8 levels remained an independent predictor LV remodeling (P = 0.025). By univariate analysis, there were positive relations between cardiovascular death or hospitalization for heart failure during the 3-year follow-up and the baseline levels of MMP-2 (P = 0.03), MMP-8 (P = 0.002), and MMP-9 (P = 0.03). By multivariate analysis, MMP-8 was the only MMP remaining significantly associated with clinical outcome (P = 0.02).
CONCLUSION
Baseline serum MMP-8 is a significant predictor of LV remodeling and cardiovascular outcome after MI and may help to improve risk stratification.
目的
心肌梗死后（MI）左心室（LV）重构的特征是结构和功能的进行性改变，称为 LV 重构。尽管已经确定了一些危险因素，如梗死面积，但 LV 重构在临床实践中仍然难以预测。细胞外基质的变化，包括基质金属蛋白酶（MMPs）和金属蛋白酶组织抑制剂（TIMPs），是 MI 后左心室（LV）重构的一个组成部分。我们研究了 MI 后患者循环 MMP 和 TIMP 的时间特征及其与 1 年时 LV 重构和 3 年时临床结局的关系。
方法
这项前瞻性多中心研究纳入了 246 例首次前壁 MI 患者。在 MI 后出院时、3 个月和 1 年进行了连续超声心动图检查，并在核心实验室进行了分析。LV 重构定义为从基线到 1 年时 LV 舒张末期容积（EDV）的百分比变化。在出院时、1 个月、3 个月和 12 个月时采集血清样本。采用多重技术分析 MMP-1、-2、-3、-8、-9、-13 和 TIMP-1、-2、-3、-4 的血清水平。
结果
MMP-8 和 MMP-9 的基线水平与 LVEDV 的变化呈正相关（分别为 P=0.01 和 0.02）。在校正主要基线特征后，MMP-8 水平仍然是 LV 重构的独立预测因子（P=0.025）。单因素分析显示，在 3 年随访期间，心血管死亡或因心力衰竭住院与 MMP-2（P=0.03）、MMP-8（P=0.002）和 MMP-9（P=0.03）的基线水平呈正相关。多因素分析显示，MMP-8 是唯一与临床结局显著相关的 MMP（P=0.02）。
结论
基线血清 MMP-8 是 MI 后 LV 重构和心血管结局的重要预测因子，可能有助于改善风险分层。
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