| PrefaceAcute coronary syndromes (ACS), are series of clinical syndromes based on the pathology of coronary atherosclerotic plaque ruptures, complete or incomplete occlusive thrombopoiesis. ACS includes unstable angina pectoris (UA), acute myocardial infarction or sudden death. The concept was proposed in the late 1980's based on the pathological research of ischemic heart disease (ICH): The collagen tissue beneath blood vessel endothelium exposes after rupture of the atherosclerotic plaques,then platelets agglomerate and thrombi come into being, which causes coronary occlude. The atherosclerotic plaque in the coronary is the immediate cause for ACS. So avoiding the rupture of the plaque is the most important means to prevent onset of ACS Members of Matrix metalloproteinase family (MMPs-1,2,3,7,8,9,12,14) are obviously augmented at the shoulders of the fragile plaques. Activated MMPs have a elevated affinity to components of ECM. The MMPs can almost degradate all the parts of ECM, including collagen fibers and elastic fibers. This effect becomes the major factor that makes the plaque unstable . Among all the members of MMPs, MMPs-3 has a wide range of specific substrates, as gelatine (type E,E,I,I), collagen(type E,I,N,O), proteoglycans (PG), fibronectin(FN) and laminin(LN). Except for degradating substrates listed abve, MMPs-3 activated by fibrinolysin hydrolysis can also triger the positive feedback loop through activating other proenzymes, which plays an key role in the MMPs family activation. Recent studies mostly focused on the measurement of increasing level of local MMPs in the atherosclerotic plaques, or the relationship between inflammatory factors and MMPs level of blood plasm, while on the contrary rare work has been done for investigating relationship among MMPs of peripheral blood and severity of coronary artery disease, numbers of coronary artery involved in; or relationship among MMPs and myocardium enzymes, troponins, and blood-fat. Our study aims at finding out dependability of MMPs of peripheral blood from ACS patients and the clinical factors mentioned above; and also trying to find out theoretical support for making MMPs a new target which will be of great use in monitoring stability of atherosclerotic plaques and improving prognosis.Materials And Methods1.General materialsFrom November 2005 to August 2006 we enrolled 77 patients who underwent percutaneous coronary intervention (PCI) or CAG in the first Affiliated Hospital of China Medical University, of which 34 patients with acute myocardial infarction, 25 patients with unstable angina pectoris, 8 patients with stable angina pectoris and 10 normal controls. All groups matched for sex, age, social background. Eliminant standard:①Infectious disease;②Hyperpyrexia and using anti-inflammation drug including the steroids and the non-steroids;③Anaemia;④Tumour;⑤Hyperthyroidism and connective tissue disease;⑥Heart dysfunction,⑦Periphery vessel disease or periphery artery sclerosis.2.The sample collected, centrifuged and keptVein blood sample 2ml of the resting patient with AMI(＜24h) or UAP was collected on the second day of hospitalization,the next morning after PCI or CAG. These samples were immediately mixed with heparin, placed 1 or 2 hours in room environment, centrifuged at 3000 rpm for 15rains. Serum was separated and stored at -70℃. The SAP group ang control group went on with the same procedure. It was defrosted and mixed before determined and refrained from refreezing. The myocardium enzyme, TnI, blood cell, serum electrolyte, renal function, the total cholesterol of serum (TC), triglyceride (TG), HDL-C, LDL-C were determined at the same time.3. Record the result of coronary angiographyAs to the result of coronary angiography, the score system of Gensini was carried on to evaluate the coronary stenosis degree4. Determination of MMP-3Serum levels of MMP-3 were determined according to EL ISA, and the operation procedure followed with the reagent instruction.5. Statistics analysisAll dates of nonnormal distribution are expressed as mean±SD. Comparisons amog the four groups were performed with T test or Pearson correlation, p＜0.05 was considered statistically significant. All dates were analyzed by SPSS13.0 statistics software.ResultsCompareing among groups Age, total cholesterol, low density lipoprotein of these patients in the four groups, are expressed as mean±SD.By t-test the difference of age and total cholesterol among every group was not statistically significant(P＞0.05). Compared with control group, the difference of low density fat of AMI, UA and SA group was statistically significant (P＜0.01). Serum level of MMP-3, expressed with mean±SD, were performed by Pearson correlation. Compared with SA group and control group, Serum level of MMP-3 in AMI group was statistically significance(P＜0.01). Compared with SA group and control group, statistical significance was seen in UA group (P＜0.01). There is no significant difference between AMI and UA group, as well as SA and control group.MMPs-3 value, CTnI and CK, CK-MB, TC, LDL-C were performed by Pearson correlation: MMPs-3 and CTnI, CK, CK-MB were positive correlation; There were no correlation between MMPs-3, TC, LDL-C.MMPs-3 value and coronary artery radiography pathological change severity were performed by Pearson correlation: There were no correlation (r=0.293; P=0.053).There were no significant difference of MMPs-3 value inl0patients with AMI before and after PCI by student t test (P＜0.01).ConclusionsMMPs plays an important role in the onset of ACS, and elevated concentration of MMPs is the major factor that causes rupture of coronary atherosclerotic plaque. It's predictable whether the plaque of the coronary atheroscterosis is stable according to the level of MMPs concerntration.No significant results was found that there was relationship between MMPs concentrations and the coronary stenosis levels demonstrated by coronary arteriongraphy.It might be possible to predict AMI at the early stage based on the results that MMPs concentrations correlate with myocardiolysis markers tested clinically.
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