目的：探讨血管重塑过程中胶原降解与冠状动脉粥样硬化不稳定斑块的关系。方法：选取已行冠脉造影检查的住院患者131例，其中冠脉造影显示管腔狭窄≥50%的患者117例，分为急性心肌梗死组39例（AMI组）、不稳定型心绞痛组54例（UAP组）、稳定型心绞痛（SAP）组24例；冠脉造影检查显示管腔狭窄<50%的患者14例为对照组（C组）。采用酶联免疫分析法测定患者血清内基质金属蛋白酶-9（MMP-9）、组织型基质金属蛋白酶抑制剂-1（TIMP-1）、MMP-9/TIMP-1及I型胶原吡啶交联终肽（ICTP）浓度。结果：MMP-9在AMI组、UAP组、SAP组、C组血清中浓度依次为（270.42±37.64）μg/L、（201.24±28.20）μg/L、（142.65±18.62）μg/L、（139.28±16.85）μg/L；TIMP-1在AMI组、UAP组、SAP组、C组在血清中浓度依次为（264.56±26.18）μg/L、（245.07±21.50）μg/L、（208.89±31.94）μg/L、（197.69±28.52）μg/L；ICTP 在 AMI组、UAP组、SAP组、C组在血清中浓度依次为（10.89±0.78）μg/L、（9.35±0.61）μg/L、（3.97±0.31）μg/L、（3.96±0.32）μg/L；MMP-9/TIMP-1在AMI组、UAP组、SAP组、C组中的比值依次为（1.020±0.077）、（0.820±0.057）、（0.700±0.060）、（0.700±0.090），数据结果提示伴随着疾病加重，胶原代谢增加。MMP-9、TIMP-1、MMP-9/TIMP-1及ICTP浓度在C组与SAP组之间比较差异无统计学意义（P>0.05），在SAP组与UAP组、UAP与AMI组之间比较差异均有统计学意义（P<0.05）。结论：冠状动脉血管重塑致不稳定斑块破裂的过程中存在胶原降解，血清内MMP-9/TIMP-1及ICTP水平有望作为评估冠脉易损斑块不稳定性的指标之一。%Objective: To study the relationship between collagen degradation in vascular remodeling and instability of coronary atherosclerosis plaque.Method: 131 inpatients who hade been through the coronary angiography exmination were selected. There were 171 patients with coronary angiography exmination≥50%, they were myocardial infarction(n=39,AMI group), unstable angina pectoris(n=54,UAP group), stable angina pectoris(n=24,SAP group),respectively. 14 patients with coronary atherosclerosis<50%. make up the control group. The concentrates of matrix metalloproteinases in serum-9 (MM-9), tissue inhibitor of matrix metalloproteinase-1 (IMP-1), MMP-9/TIMP-1 and I-Collagen carboxy terminal telopeptide (ICTP) were analyzed by enzyme immunoassay.Result: The concentrates of MMP-9 were (270.42±37.64) μg/L, (201.24±28.20) μg/L, (142.65±18.62) μg/L and (139.28±16.85) μg/L for groups AMI, UAP, SAP and C, respectively. The concentrates of TIMP-1 were (264.56±26.18) μg/L, (245.07±21.50) μg/L, (208.89±31.94) μg/L and (197.69±28.52) μg/L, for groups AMI, UAP SAP and C, respectively. The concentrates of ICTP were (10.89±0.78) μg/L, (9.35±0.61) μg/L, (3.97±0.31) μg/L and (3.96±0.32) μg/L for groups AMI, UAP, SAP and C, respectively. The concentrates ratios of MMP-9/TIMP-1 were (1.020±0.077), (0.820±0.057), (0.700±0.060) and (0.700±0.090) for groups AMI, UAP, SAP and C, respectively. The above data suggests that the collagen metabolism increase with the aggravation of disease.The concentrate divergences of MMP-9, TIMP-1, MMP-9/TIMP-1 and ICTP between group C and SAP had no statistically meaning (P>0.05). The concentratesdivergences of MMP-9, TIMP-1, MMP-9/TIMP-1 and ICTP between groups SAP and UAP, groups UAP and AMI had statistically meaning (P<0.05).Conclusion:The progress of oronary arterial remodeling and vulnerability plate rupture with collagen degradation. The concentrates ratios of MMP-9/TIMP-1 and the concentrates of ICTP in serum may be the indexes for evaluating the instability about unstable plaque of coronary heart disease.
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