经皮球囊二尖瓣成形术后晚期二尖瓣再狭窄：炎症和细胞外基质重塑生物标志物的预测价值

Late mitral restenosis after percutaneous commissurotomy: Predictive value of inflammation and extracellular matrix remodeling biomarkers.

作者信息

Mechmeche Rachid, Zaroui Amira, Aloui Sonia, Boukhris Marouane, Allal-Elasmi Monia, Kaabachi Naziha, Zouari Bechir

机构信息

Cardiology Department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.

出版信息

Heart Lung. 2017 Jul-Aug;46(4):258-264. doi: 10.1016/j.hrtlng.2017.03.006. Epub 2017 Apr 24.

DOI:10.1016/j.hrtlng.2017.03.006

PMID:28450150

Abstract

BACKGROUND

The role of chronic inflammation in mitral restenosis after percutaneous mitral commissurotomy (PMC) is still controversial.

AIMS

We sought to assess the predictive value of inflammation and extracellular matrix (ECM) remodeling biomarkers in late mitral restenosis after PMC.

METHODS

We prospectively enrolled 155 patients (mean age 46.2±11 years) with at least 5 year follow up after primary PMC. Serum levels of high sensitive C-Reactive Protein (hs-CRP), matrix metalloproteinases MMPs, tissue-specific inhibitors of matrix metalloproteinases TIMPs, and tumor necrosis factor α (TNFα)] were measured.

RESULTS

Late mitral restenosis occurred in 55 patients (35.5%). The independent predictors of late mitral stenosis were: age> 55 years [HR10.51 (95%CI 1.12-95.9); p=0.037]; no long acting penicillin therapy [HR 18.1 (95% CI 2.6-122.9); p=0.003]; TNFα > 80 ng/ml [HR 5.85 (95% CI 1.1-31.42); p=0.039]; and TIMP-2 > 289 ng/ml [HR 0.52 (95% CI 0.22-0.95); p=0.045].

CONCLUSION

Chronic inflammation and ECM remodeling are involved in late mitral restenosis after PMC.

摘要

背景

慢性炎症在经皮二尖瓣交界切开术（PMC）后二尖瓣再狭窄中的作用仍存在争议。

目的

我们试图评估炎症和细胞外基质（ECM）重塑生物标志物对PMC后晚期二尖瓣再狭窄的预测价值。

方法

我们前瞻性纳入了155例患者（平均年龄46.2±11岁），这些患者在初次PMC后至少随访了5年。测量了血清高敏C反应蛋白（hs-CRP）、基质金属蛋白酶（MMPs）、基质金属蛋白酶组织特异性抑制剂（TIMPs）和肿瘤坏死因子α（TNFα）的水平。

结果

55例患者（35.5%）发生了晚期二尖瓣再狭窄。晚期二尖瓣狭窄的独立预测因素为：年龄>55岁[风险比（HR）10.51（95%置信区间1.12 - 95.9）；p = 0.037]；未接受长效青霉素治疗[HR 18.1（95%置信区间2.6 - 122.9）；p = 0.003]；TNFα>80 ng/ml[HR 5.85（95%置信区间1.1 - 31.42）；p = 0.039]；以及TIMP-2>289 ng/ml[HR 0.52（95%置信区间0.22 - 0.95）；p = 0.0