Expression And Significance Of Mmp-9 And Mmp-12 In Patients With Acute Coronary Disease

BackgroundCardiovascular disease is a serious and common disease to human being,and has become the leading cause of death in our country.With the improvement of our lives, cardiovascular disease,especially coronary atherosclerotic heart disease,also known as coronary heart disease(CHD),is gradually increasing yearly.And people have gotten more profound understanding of its occurrence and development.Acute coronary syndrome(ACS) is the most important causes of death in cardiovascular disease,including unstable angina pectoris(UAP),non-ST-segment elevation myocardial infarction(NSTEMI) and ST-segment elevation myocardial infarction (STEMI).ACS central link are instability and even rupture of atherosclerosis(AS) plaque,on which thrombus formed.And in this process inflammation and immunity played an important role.Looking for specific and sensitive markers which can reflect the characteristics of unstable plaque,serological target in particular,is a hot clinical problem to people. Research confirms that matrix metalloproteinases(MMPs) not only played an important role in occurrence and development of AS through degrading extra cellular matrix(ECM),injuring arterial wall and inner film,and impacting lipid deposition, but promoted rupture and thrombosis of atherosclerotic plaque by degrading collagen, weakening the structure of fibrous cap,increasing instability of the atherosclerotic plaque.Therefore the increasing MMPs are probably one of the main reasons which caused ACS happened. ObjectiveThis study was to measure the serum levels of MMP-9 and MMP-12,at the same time,coronary angiography(CAG) were conducted in patients with acute myocardial infarction(AMI),UAP,stable angina pectoris(SAP) and normal subjects without CHD to investigate the value of predicting of coronary atherosclerotic plaque instability and the risk degrees of patients with CHD,and to evaluate the clinical value as a high sensitive and specific markers that can reflect the characteristic of coronary unstable atherosclerotic plaque and define high-risk patients with CHD, especially MMP-12 which is discovered in recently.In this way can guide us to interfere with high-risk patients with CHD earlier.MethodsAll subjects came from the inpatient-Department of Cardiology,the First Affiliated Hospital of Zhengzhou University from April 2008 to July 2008.70 patients with CHD diagnosed by clinical featuers,ECG and CAG,and in line with the diagnostic criteria of the American College of Cardiology(ACC) and American Heart Association(AHA).These patients were divided into three groups:15 patients in AMI group;44 patients in UAP group;11 patients in SAP group.13 normal subjects without CHD confirmed by CAG served as the control group.Enzyme linked immunosorbent assay(ELISA) was used to measure the serum levels of MMP-9 and MMP-12 in patients with CHD and control group.CAG are manipulated by skilled cardiac physicians.The severity scale of coronary artery stenosis was quantitatively assessed according to CAG by Gensini scoring system.Results1.The difference of sex,age,smoking history,diabetes,hypertension and blood fat was not significant between AMI,UAP,SAP and the control group.2.The Gensini score of coronary artery in AMI,UAP and SAP group was 56.00±23.46,55.95±40.89 and 46.33±47.99 respectively,and there were not significant differences among them.3.The mean level of serum MMP-9 was 10.28±1.39μg/L,8.93±1.78μg/L, 6.23±1.70μg/L and 4.37±1.38μg/L respectively in AMI,UAP,SAP and the control group;the concentration of serum MMP-12 was 3.43±0.88μg/L,2.96±1.46μg/L, 1.95±0.41μg/L and 1.63±0.60μg/L respectively.Compared control group with SAP group,the level of serum MMP-9 and MMP-12 was markedly increased in UAP and AMI group(P＜0.01),and no significant difference was found between SAP group and the control group.In the patients with AMI group,the level of MMP-9 and MMP-12 was slightly higher than that of the patients with UAP group,but no significant difference.4.A significant positive correlation was found between the serum levels of MMP-9 and MMP-12 in AMI group(r=0.709,P＜0.01),UAP group(r=0.582,P＜0.01) and ACS group(UAP and AMI group)(r=0.592,P＜0.01).No correlation was found between the serum level of MMP-9 and Gensini score in the CHD group(AMI,UAP and SAP group)(r=0.040,P＞0.05),and the same with different branch vessel lesions in the CHD group(AMI,UAP and SAP group)(r=0.122,P＞0.05).No correlation was found between the serum level of MMP-12 and Gensini score in the CHD group (AMI,UAP and SAP group)(r=-0.196,P＞0.05),also the same with different branch vessel lesions in the CHD group(AMI,UAP and SAP group)(r=-0.110,P＞0.05).Conclusion1.The serum levels of MMP-9 and MMP-12 may act as one of the biomarkers of predicting stability of atherosclerotic plaque,but may not reflect the severity of coronary artery stenosis.2.The serum level of MMP-12 which is the same with MMP-9,may act as one of the targets of risk factors for ACS.And a significant positive correlation was found between the levels and the risk degree of CHD.3.The serum levels of MMP-9 and MMP-12 have a close relationship with the stability of atherosclerotic plaque.And they have changed early before ACS occurred. So both of them may will be as important targets of early diagnosis and evaluation of the treatment effect of ACS.