MMP-9联合NT-proBNP在非ST段抬高急性冠脉综合征危险分层的研究
Combined use of matrix metalloproteinase-9 and N-terminal pro-brain natriuretic peptide in risk stratification of non-ST elevation acute coronary syndrome

摘要：目的 探讨N末端脑钠肽(NT-proBNP)、基质金属蛋白酶-9(MMP-9)在非ST段抬高急性冠脉综合征(NSTE-ACS)危险分层、预后评估中的作用及相互关系。方法 连续收入因胸闷、胸痛至我院心内科住院的NSTE-ACS患者共114例，按照GRACE评分分为高危、中危、低危组，另设正常对照组58例，酶联免疫吸附法测定MMP-9浓度，电化学发光法测定NT-proBNP浓度，Gensini积分表示冠脉病变程度，并对主要不良心脏事件(MACE)的发生情况进行随访6个月。结果 ①MMP-9、lgNT-proBNP水平在各组间具有显著性差异(P<0.05)；②ROC曲线分析显示lgNT-proBNP水平可预测NSTE-ACS随访期MACE，其曲线下面积为0.795，截断值2.069，相应NT-proBNP值为116.56ng/L；MMP-9水平可预测NSTE-ACS随访期MACE，其曲线下面积为0.696，截断值32.49ng/mL；2项指标均异常预测MACE的灵敏度为80.41%，特异度为82.19%，正确诊断指数为0.63。③Cox回归分析显示，MMP-9及NT-proBNP均异常与随访期MACE发生率独立相关，OR值为3.751。结论 MMP-9与NT-proBNP可以作为NSTE-ACS危险分层的血清学指标，二者联合应用可显著提高MACE的风险预测水平。
ABSTRACT: Objective To explore the role and relationship of N-terminal pro-brain natriuretic peptide (NT-proBNP) and matrix metalloproteinase-9 (MMP-9) in risk stratification and prognosis assessment of non-ST elevation acute coronary syndrome (NSTE-ACS). Methods We recruited 114 patients with NSTE-ACS and classified them into three groups according to the GRACE risk stratification: high-risk, intermediate-risk and low-risk groups. Another 58 patients were recruited as controls. Arterial blood was collected before angiography for the measurement of serum NT-proBNP and MMP-9. Gensini score was used to evaluate the degree of coronary artery stenosis. All the patients were followed up for 6 months and MACE was observed and recorded. Results ① The levels of lg NT-proBNP and MMP-9 significantly differed between the groups (P<0.05). ② ROC curve analysis showed that lg NT-proBNP could predict MACE of NSTE-ACS; area under the curve was 0.795, the cutoff value was 2.069, corresponding to the NT-proBNP value of 116.56 ng/L. MMP-9 could predict MACE of NSTE-ACS; area under the curve was 0.696, the cutoff value was 32.49 ng/ml; both of the abnormal indexes could predict MACE with the sensitivity of 80.41%, specificity of 82.19%, and Youden’s index of 0.63. ③ Cox regression analysis showed that abnormal MMP-9 and NT-proBNP levels were independently related to the incidence of MACE by the value of OR as 3.751. Conclusion MMP-9 and NT-proBNP may be used as serological indicators in risk stratification of NSTE-ACS. The combined use of NT-proBNP and MMP-9 increases the power of predicting MACE