Ascoli Marchetti A, Pratesi G, Di Giulio L, Battistini M, Massoud R, Ippoliti A
Vascular Surgery, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
Vascular Surgery, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
J Med Vasc. 2017 Feb;42(1):21-28. doi: 10.1016/j.jdmv.2017.01.004. Epub 2017 Apr 18.
The aim of our study is to verify the role of metalloproteinases in endovascular repair (EVAR) and OPEN surgery treatment for abdominal aortic aneurysm (AAA). Postoperatively, these enzymes could represent an important biomarker to adapt diagnostic tests and further investigations during follow-up.
From 2004 to 2008, 55 patients were considered with AAA. Of these, 33 patients (mean age: 70.1 years), (mean AAA diameter: 5.4cm) were treated with OPEN surgery (group A) and 22 (mean age: 74.1 years) (mean AAA diameter: 5.1cm) were treated with EVAR. In 17 of them, there were no signs of endoleak (group B1), while in 5 patients, a presence of endoleak (group B2) was detected. Plasma samples were collected in order to determine MMP-9 activity. Enzyme immunoassay was performed preoperatively at 1, 3, 6 and 12 months. Patients treated conventionally were clinically examined after 1 and 12 months by ultrasound. Patients undergoing EVAR treatment were clinically examined by CT scan after 1, 3, 6 and 12 months. The analysis was done by assessing the interaction over time of the MMP-9 value in B1 and B2 groups.
The average values observed for MMP-9 were preoperatively and at 1, 3, 6 and 12 months, respectively: in group A 150.8ng/mL (SD=30.5), 252.5ng/mL (SD=25.2), 315.4ng/mL (SD=22.7), 295.3ng/mL (SD=26.8), 210.7ng/mL (SD=30.2); in group B1 105ng/mL (SD=10.8), 125.6ng/mL (SD=18), 85.8ng/mL (SD=19.9), 95ng/mL (SD=20.2), 80.4ng/mL (SD=15.6); in group B2 149ng/mL (29.2), 375.4ng/mL (SD=40.2), 215ng/mL (SD=35.9), 180ng/mL (SD=20.2), 175ng/mL (SD=33.4). The MMP-9 level was higher in group B2 compared to group B1 (P=0.01), suggesting a correlation with the presence of the endoleak.
This preliminary study shows that MMP-9 may be a biomarker of the presence of endoleak. Other further investigations and larger series are needed to show that metalloproteases could play a role in the follow-up of EVAR treated patients.
我们研究的目的是验证金属蛋白酶在腹主动脉瘤（AAA）血管内修复术（EVAR）和开放手术治疗中的作用。术后，这些酶可能是调整诊断测试以及随访期间进一步检查的重要生物标志物。
2004年至2008年，共纳入55例腹主动脉瘤患者。其中，33例患者（平均年龄：70.1岁）（平均腹主动脉瘤直径：5.4cm）接受开放手术治疗（A组），22例患者（平均年龄：74.1岁）（平均腹主动脉瘤直径：5.1cm）接受EVAR治疗。其中17例无内漏迹象（B1组），5例检测到内漏（B2组）。采集血浆样本以测定基质金属蛋白酶-9（MMP-9）活性。术前及术后1、3、6和12个月进行酶免疫测定。接受传统治疗的患者在1个月和12个月后通过超声进行临床检查。接受EVAR治疗的患者在术后1、3、6和12个月通过CT扫描进行临床检查。通过评估B1组和B2组中MMP-9值随时间的相互作用进行分析。
术前及术后1、3、6和12个月观察到的MMP-9平均值分别为：A组150.8ng/mL（标准差=30.5）、252.5ng/mL（标准差=25.2）、315.4ng/mL（标准差=22.7）、295.3ng/mL（标准差=26.8）、210.7ng/mL（标准差=30.2）；B1组105ng/mL（标准差=10.8）、125.6ng/mL（标准差=18）、85.8ng/mL（标准差=19.9）、95ng/mL（标准差=20.2）、80.4ng/mL（标准差=15.6）；B2组149ng/mL（29.2）、375.4ng/mL（标准差=40.2）、215ng/mL（标准差=35.9）、180ng/mL（标准差=20.2）、175ng/mL（标准差=33.4）。B2组的MMP-9水平高于B1组（P=0.01），提示与内漏的存在相关。
这项初步研究表明，MMP-9可能是内漏存在的生物标志物。需要进一步的研究和更大规模的系列研究来表明金属蛋白酶在接受EVAR治疗患者的随访中可能发挥作用。
