The Relationship Between Serum PAI-1, MMP2 Level And Acute Coronary Syndrome In The Patients With Metabolic Syndrome

Backgrounds:The patients with metabolic syndrome who have more cardiovascular risk factors are more likely to have acute cardiovascular events. It is well known that the occurrence of acute cardiovascular events depends on the vulnerability of plaque. Three main factors is associated with: vulnerable plaque, vulnerable blood and vulnerable myocardium . Plaque vulnerability depends on the main internal characteristics (composition of plaque) and external (such as machinery and hemodynamics) factors of the plaque. Of these the former is more easily rupture, which decide the specific time of rupture. Unstable plaques have thin-fibrous cap. There are a large number of inflammatory cells and the less smooth muscle cells in the fibrous cap. Positive vascular remodeling and inflammatory response and apoptosis involve in the formation of vulnerable plaque in the whole process. At present there are many ways to detect the plaque vulnerability including serological detection reflecting inflammation such as: high sensitivity CRP, nuclear transcription factor NF-kB; reflecting fibrinolytic coagulation abnormalities: tPA, fibrinogen; reflecting matrix degradation: TIMP and MMPs, and some imaging studies such as high-frequency ultrasound of carotid artery, intravascular ultrasound, vascular microscopy, laser coherence tomography, magnetic resonance imaging and radionuclide techniques such as scintigraphy. However, these methods are defective and could not fully reflect the risks of cardiovascular. There is no evaluation methodologies for cardiovascular risk in MS at home and abroad .Patients with metabolic syndrome have a higher incidence of cardiovascular events, and cardiovascular events have a high mortality rate, the detection of plaque vulnerability is great urgency and necessity.Objectives:To research the ability of serum plasminogen activator inhibitor-1 (PAI-1), pro-matrix metalloproteinase-2 (pro-MMP2), matrix metalloproteinase 2 (MMP2) in predicting cardiovascular events in MS , and study relationships between the cardiovascular risk factors and those of PAI-1 respectively.Methods:Using enzyme-linked immunosorbent assay and gel electrophoresis detection serum concentration of PAI-1, pro-MMP2 and MMP2 in 88 cases of metabolic syndrome (MS) with acute coronary syndrome (ACS) group, 88 patients with acute coronary syndrome (ACS) group, 40 patients with stable angina(SA) group,48 healthy group (the normal group).Results:Serum PAI-1,pro-MMP2 and MMP2 concentration in MS + ACS group significantly was higher than other groups, with significant differences(P <0.01), body mass index increased significantly correlated serum PAI-1 .in ACS group serum pro-MMP2, MMP2 concentration was higher than the normal control group, with statistically significant differences (P <0.01) .The serum pro-MMP2 and MMP2 levels increased in SA group, the differences were statistically significant (P <0.01). High blood glucose,hypertension and LDL were significantly correlated with PAI-1, serum PAI-1 levels were significantly correlated with the pro-MMP2,but levels are negatively correlated with serum MMP2. Discussion:PAI-1 levels in MetS demonstrate not only hypercoagulation but the vulnerability of atherosclerosis plaque in the artery wall ,so they have higher predictive value for cardiovascular events. And MMP2 plays an important role of the matrix degradation in the artery wall ,so it has high diagnostic value for plaque vulnerability .Both can better predict the occurrence of cardiovascular events and reflect vascular remodeling extraversion. Plasma PAI-1,MMP2 and coronary angiography which is an assessment of vulnerable myocardium together could be an more comprehensive assessment of cardiovascular events risks than alone.