Objective To investigate the effect of time from myocardial infarction (MI) onset to percutaneous coronary intervention (PCI) on plasma matrix metalloproteinases (MMPs) level and left ventricle (LV) remodeling in patients with acute ST-segment elevation myocardial infarction of anterior wall,and the relationship between MMPs and left ventricular remodeling.Methods All patients with anterior wall STEMI undergoing PCI were divided into early PCI group (PCI within 18 h after MI onset) and delayed PCI group (PCI between 2 and 3 weeks after MI onset).Plasma MMP-2 and MMP-9 activities were assayed on admission,and at 2 days,1 week after admission.One-year follow-up was finished after PCI.Left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV) and left ventricle ejection fraction (LVEF) were measured by echocardiography at baseline and one year later to elucidate the effects of time from onset to PCI on LV remodeling and the relationship between MMP-2,-9 levels and LV remodeling.Results The MMP -9 activity at 2 days after myocardial infarction was lower in early PCI group than in delayed PCI group [(46±26)μg/L vs.(66±40) μg/L,P=0.000].The changes in LVEDV and LVESV (△LVEDV and △LVESV) were lower and the change in LVEF (△LVEF) was higher in early PCI group than in delayed PCI group [(10.9±6.2) ml vs.(15.0±6.0)ml,(-1.1±5.7) ml vs.(2.9±4.6) ml,(5.5 ±4.0) ％ vs.(3.8±3.4) ％,P=0.000,0.000 and 0.015].MMP-9 had positive correlations with △LVEDV and △LVESV,and a negative correlation with △LVEF at admission and after 1-year follow-up (r=0.32,0.36 and-0.29,respectively,P=0.000,0.000 and 0.001).Conclusions MMP-9 activity at admission is correlated with LV remodeling and LV function.Early PCI can reduce MMP-9 activity and improve LV remodeling after myocardial infarction.%目的 探讨经皮冠状动脉介入术(PCI)治疗时间对急性ST段抬高型前壁心肌梗死(ASTEAWMI)患者血浆中基质金属蛋白酶(MMPs)和左心室重构的影响及MMPs与左心室重构的相关性. 方法 ASTEAWMI患者根据入院后PCI时间分为早期PCI组(发病至PCI＜18 h)72例和延迟PCI组(发病至PCI为2～3周)52例.检测心肌梗死后不同时间点MMP-2和MMP-9的活性;对比入院时及随访1年后的心脏超声检查结果,分析左心室舒张末期容积(LVEDV),左心室收缩末容积(LVESV)和左心室射血分数(LVEF)的变化及MMPs与左心室重构的相关性. 结果 早期PCI组心肌梗死后2d时MMP-9活性低于延迟PCI组,分别为(46±26) μg/L比(66±40) μg/L,(P=0.000);早期PCI组的LVEDV、LVESV变化低于延迟PCI组,分别为(10.9±6.2)ml比(15.0±6.0)ml、(-1.1±5.7)ml比(2.9±4.6)ml(均P=0.000),而LVEF变化高于延迟PCI组(5.5±4.0)％比(3.8±3.4)％(P=0.015);入院时、随访1年MMP-9的活性与LVEDV和LVESV变化呈正相关(r值分别为0.32、0.36,均P=0.000),与LVEF变化呈负相关(r=-0.29,P=0.001).结论 入院时MMP-9活性与心肌梗死后左心室重构和左心室功能相关,早期PCI可降低血浆中MMP-9的活性,改善心肌梗死后左心室重构情况.
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