【摘要】 目的 探讨血清基质金属蛋白酶9(MMP-9)、甲壳质酶蛋白40(YKL-40)水平与老年冠心病患者冠状动脉脂质斑块稳定性的关系。方法 选取2021年8月至2022年8月郑州市第七人民医院心内科收治的老年冠心病患者128例为实验组，另选取同期行常规体检的老年体检者50例为对照组，采用ELISA法检测2组血清MMP-9、YKL-40水平，采用光学相干断层扫描测定实验组冠状动脉脂质斑块纤维帽厚度(FCT),应用Pearson单因素分析及ROC曲线评估实验组冠心病患者血清MMP-9、YKL-40水平预测冠状动脉FCT的临床价值。结果 实验组血清MMP-9、YKL-40水平高于对照组[(186.98±22.36)μg/L vs(56.36±12.02)μg/L,(89.28±6.22)μg/L vs(18.25±3.26)μg/L,P<0.01]。实验组稳定性心绞痛、不稳定性心绞痛、急性心肌梗死患者MMP-9、YKL-40逐渐升高，FCT逐渐降低；冠状动脉病变支数越多，心功能分级越高，MMP-9、YKL-40越高，FCT越低(P<0.05)。Pearson单因素分析显示，实验组血清MMP-9、YKL-40水平与冠状动脉FCT呈负相关(r=-0.458,-0.402,P<0.05)。ROC曲线分析显示，实验组血清MMP-9、YKL-40联合检测冠状动脉FCT<65μm的曲线下面积高于单一指标检测(0.882 vs 0.755、0.782,P<0.01)。结论 血清MMP-9、YKL-40水平升高与老年冠心病的发生发展密切相关，且血清MMP-9、YKL-40联合检测可有效预测冠状动脉FCT,有助于临床对斑块稳定性的判断。更多还原

【Abstract】 Objective To investigate the relationship of the serum levels of matrix metalloproteinase-9(MMP-9) and chitinase protein 40(YKL-40) with the stability of coronary lipid plaques in the elderly patients with coronary heart disease(CHD).Methods A total of 128 elderly CHD patients admitted to our department from August 2021 to August 2022 were selected as experimental group, and another 50 elderly patients who taking routine physical examination at the same time period served as control group.The serum levels of MMP-9 and YKL-40 were measured by ELISA.Fibrous cap thickness(FCT) of coronary lipid plaques in the patients of the experimental group were measured by optical coherence tomography.Pearson correlation analysis and receiver operating characteristic curve analysis were used to determine the clinical values of the two indicators in predicting FCT of coronary lipid plaques in CHD patients.Results The serum levels of MMP-9 and YKL-40 were significantly higher in the experimental group than the control group(186.98±22.36 μg/L vs 56.36±12.02 μg/L,89.28±6.22 μg/L vs 18.25±3.26 μg/L,P<0.01).For the patients with stable angina pectoris, unstable angina pectoris and acute myocardial infarction, MMP-9 and YKL-40 were increased gradually, while FCT was decreased gradually.With the increase of number of coronary stenosis branches and NYHA grades, the serum levels of MMP-9 and YKL-40 were gradually increased, while the FCT of coronary lipid plaque was gradually decreased(P<0.05).Pearson correlation analysis indicated that the levels of serum MMP-9 and YKL-40 in patients with CHD were negatively correlated with the FCT of coronary lipid plaque(r=-0.458,-0.402,P<0.05).The area under the curve(AUC) of serum MMP-9 and YKL-40 levels CHD in patients in predicting FCT of coronary lipid plaque(<65 μm) was higher than that of single index(0.882 vs 0.755 and 0.782,P<0.01).Conclusion The increase of serum MMP-9 and YKL-40 levels is closely associated to the occurrence and development of CHD,and their combination can effectively predict FCT of coronary lipid plaque, which is helpful for clinical evaluation of plaque stability.更多还原