【摘要】 目的 探讨冠状动脉粥样硬化性心脏病（coronary heart disease, CHD）患者血清基质金属蛋白酶-9（matrix metalloproteinase-9, MMP-9）、血管生成素样蛋白2（angipoietin-like protein 2, Angptl2）与冠状动脉粥样硬化易损斑块、冠状动脉病变程度的相关性。方法 选取2023年3月至2024年3月于沧州市人民医院进行诊治的142例CHD患者作为研究组，根据Gensini评分，分为低危患者40例，中危患者60例，高危患者42例；根据冠状动脉斑块性质，分为无斑块患者49例，稳定斑块患者59例，易损斑块患者34例；根据冠状动脉造影检查结果，分为1支病变患者44例，2支病变患者57例，3支及以上病变患者41例。同时期选取142名健康体检人群作为对照组。酶联免疫吸附试验（enzyme-linked immunosorbent assay, ELISA）检测血清MMP-9、Angptl2浓度。采用Spearman分析CHD患者血清MMP-9、Angptl2与易损斑块、病变支数、Gensini评分的相关性。采用多因素Logistic回归分析CHD患者冠状动脉病变程度的影响因素。采用受试者工作特征曲线（receiver operating characteristic curve, ROC）评估MMP-9、Angptl2浓度对CHD高危患者的诊断效能。结果 研究组患者的血清MMP-9浓度[（59.14±6.94）ng/mL vs.（33.25±4.67）ng/mL,P<0.05]、Angptl2浓度[（4.09±0.86）ng/mL vs.（2.17±0.42）ng/mL,P<0.05]显著高于对照组，差异有统计学意义。血清MMP-9浓度在无斑块组、稳定斑块组、易损斑块组患者中依次升高，差异有统计学意义[（53.33±5.46）ng/mL vs.（60.25±6.53）ng/mL vs.（65.58±7.62）ng/mL,P<0.05]；血清Angptl2浓度在无斑块组、稳定斑块组、易损斑块组患者中依次升高，差异有统计学意义[（2.91±0.44）ng/mL vs.（4.15±0.79）ng/mL vs. 5.68±0.99)ng/mL,P<0.05]。随着冠状动脉病变支数的增加，血清MMP-9、Angptl2浓度逐渐上升，差异有统计学意义（P<0.05）。血清MMP-9浓度在高危组、中危组、低危组患者中依次下降，差异有统计学意义[（62.58±7.69）ng/mL vs.（59.22±7.23）ng/mL vs.（55.42±6.52）ng/mL,P<0.05]；血清Angptl2浓度在高危组、中危组、低危组患者中依次下降，差异有统计学意义[（5.21±1.72）ng/mL vs.（4.01±0.57）ng/mL vs.（3.05±0.45）ng/mL,P<0.05]。Gensini评分在高危组、中危组、低危组患者中依次降低，差异有统计学意义[（48.11±6.14）分vs.（29.14±4.48）分vs.（13.58±2.56）分，P<0.05]。由Spearman相关性分析可知，血清MMP-9、Angptl2浓度与易损斑块、病变支数、Gensini评分呈正相关（P<0.05）。多因素Logistic回归分析发现，MMP-9、Angptl2均是影响CHD患者冠状动脉病变程度的危险因素（P<0.05）。由ROC分析可知，血清MMP-9浓度单独诊断CHD高危患者的曲线下面积（area under the curve, AUC）值为0.702，血清Angptl2浓度单独诊断CHD高危患者的AUC值为0.798，二者联合诊断时，AUC提升为0.836(Z_{联合vs. MMP-9}=2.434、Z_{联合vs. Angptl2}=2.566,P<0.05)。结论 CHD患者血清中MMP-9、Angptl2的浓度显著升高，二者与冠状动脉粥样硬化易损斑块、冠状动脉病变程度相关，且二者联合检测能够有效诊断CHD高危患者。更多还原

【Abstract】 Objectives To investigate the correlations between serum concentrations of matrix metalloproteinase-9（MMP-9） and angipoietin-like protein 2（Angptl2） with coronary atherosclerotic vulnerable plaques and coronary artery lesions in patients with coronary heart disease（CHD）. Methods A total of 142 CHD patients who were diagnosed and treated in Cangzhou People’s Hospital from March 2023 to March 2024 were selected as study group. According to the Gensini score, 40 cases were low-risk patients, 60 cases were intermediate-risk patients, and 42 cases were high-risk patients. According to the nature of coronary plaque, there were 49 patients with no plaque, 59 patients with stable plaque, and 34 patients with vulnerable plaque. According to the results of coronary angiography（CAG）, there were 44 patients with 1 lesion, 57 patients with 2 lesions, and 41 patients with 3 or more lesions. Meantime, 142 healthy people were selected as control group. Enzyme-linked immunosorbent assay（ELISA） was used to detect the serum concentrations of MMP-9 and Angptl2. Spearman was used to analyze the correlation between serum concentrations of MMP-9 and Angptl2 with vulnerable plaques, lesion count and Gensini score in CHD patients. Multivariate Logistic regression was used to analyze the influencing factors of coronary artery lesions in CHD patients. Receiver operating characteristic curves（ROCs） were used to evaluate the diagnostic efficacy of MMP-9 and Angptl2 in patients with high risk of CHD. Results The serum concentrations of MMP-9 [（59.14±6.94） ng/mL vs.（33.25±4.67） ng/mL, P<0.05] and Angptl2 [（4.09±0.86） ng/mL vs.（2.17±0.42） ng/mL, P<0.05] in study group were obviously higher than those in control group. The serum concentrations of MMP-9 in non-plaque group, stable plaque group and vulnerable plaque group were gradually increased [（53.33±5.46） ng/mL vs.（60.25±6.53） ng/mL vs.（ 65.58±7.62） ng/mL, P<0.05]; serum concentrations of Angptl2 in non-plaque group, stable plaque group and vulnerable plaque group were gradually increased[（2.91±0.44） ng/mL vs.（4.15±0.79） ng/mL vs. 5.68±0.99) ng/mL, P<0.05]. With the increase of the number of coronary artery lesions, the serum concentrations of MMP-9 and Angptl2 increased gradually（P<0.05）. The serum concentrations of MMP-9 in high-risk group, mediumrisk group and low-risk group were gradually decreased[（62.58±7.69） ng/mL vs.（ 59.22±7.23） ng/mL vs.（55.42±6.52） ng/mL, P<0.05]; serum concentrations of Angptl2 in high-risk group, medium-risk group and low-risk group were gradually decreased[（5.21±1.72） ng/mL vs.（4.01±0.57） ng/mL vs.（3.05±0.45） ng/mL, P<0.05]. Gensini scores in high-risk group, medium-risk group and low-risk group were gradually decreased[（48.11±6.14） scores vs.（29.14±4.48） scores vs.（13.58±2.56） scores, P<0.05]. Spearman correlation analysis showed that serum concentrations of MMP-9 and Angptl2 were positively correlated with vulnerable plaques, lesion count and Gensini score（P<0.05）. Multivariate Logistic regression analysis showed that MMP-9 and Angptl2 were risk factors for the degree of coronary artery lesions in CHD patients（P<0.05）. According to the analysis of ROC, the area under the curve（AUC） for diagnosing CHD high-risk patients with serum concentration of MMP-9 alone was 0.702, the AUC value for diagnosing CHD high-risk patients with serum concentration of Angptl2 alone was 0.798, the combined diagnosis AUC of the two was 0.836(Z_{combination vs. MMP-9}=2.434, Z_{combination vs. Angptl2}=2.566, P<0.05). Conclusions The serum concentrations of MMP-9 and Angptl2 in CHD patients are obviously increased, which are related to vulnerable plaque of coronary atherosclerosis and the degree of coronary lesions. The combined detection of MMP-9 and Angptl2 can effectively diagnose CHD high-risk patients.更多还原