The Significance Of Extracellular Matrix Metalloproteinaseinducer,Urokinase-type Plasminogen Activator In The Patients With Acute Coronary Syndrome

Aim To explore the association between extracellular matrix metalloproteinase inducer (EMMPRIN) and urokinase-type plasminogen activator(uPA) and the severity of coronary artery lesions in coronary heart disease (CHD) patients. Some patients underwent64-slice spiral compyted tomography coronary artery imaging,to evaluate the clinical value of64-slice spiral computed tomography combined EMMPRIN and uPA to detect the vulnerable plaque of acute coronary syndrome.Methods There were totally176patients selected and136in CHD group including88in acute coronary syndrome group (ACS group) and48in stable angina pectoris group (SAP group), and40in control group. THE CHD patients including34S-T elevation myocardial infarction group(STEMI group),23Non-S-T elevation myocardial Infarction group(NSTEMI group) and31unstable angina pectoris group(UAP group).The expression of EMMPRIN and uPA detected, and at the same time, coronary angiography (CAG) was used selectively for defining the pathological changes of coronary artery. The level of EMMPRIN and uPA was observed among different vessels, status and types of CHD. At the same time,108patients with coronary heart disease underwent64-slice spiral computed tomography coronary artery imaging. type Ⅰ plaque group(33patients), type Ⅱ plaque group(59patients) and typⅢ plaque group(44patients) through plaque morphology characteristics according to coronary angiography. Coronary artery plaques were divided into Soft plaque group(42patients), Fibrous plaque group(34patients) and Calcified plaque group(32patients) according to CT characteristics. The changes of EMMPRIN、uPA levels in the patients with different plaque types were compared. Based on Gensini score standards to quantitative assess the extent of coronary artery disease.The mean fluorescence intensity (MFI) of EMMPRIN on monocytes of peripheral blood (PBMCs)were examined by flow cytometry. uPA in serum was measured with ELISAResults①. Coronary artery plaque was the main type Ⅱ plaque group (48patients) and Soft plaque group (35patients) in the ACS patients. Coronary artery plaque was the main type I plaque group (20patients) and type Ⅲ plaque group (17patients) and Fibrous plaque group (16patients) and Calcified plaque group (22patients) in the SAP patients.②. The expression of EMMPRIN levels in the patients of STEMI group(MFI:12.14±0.62), NSTEMI group(MFI:10.91±1.42) were significantly higher than those in the patients of UAP group (MFI:8.75±1.17)(P<0.05). The expression of EMMPRIN levels in the patients of STEMI group(MFI:12.14±0.62) were significantly higher than those in the patients of NSTEMI group(MFI:10.91±1.42)(P<0.05). The expression of uPA levels in the patients of STEMI group(0.91±0.13mg/L), NSTEMI group(0.89±0.04mg/L) were ignificantly higher than those in the patients of UAP group (0.66±0.07mg/L)(P<0.05). The expression of EMMPRIN levels in the patients of STEMI group(0.91±0.13mg/L) were significantly higher than those in the patients of NSTEMI group(MFI:0.89±0.04mg/L)(P<0.05).③. The expression of EMMPRIN levels in the patients of ACS group(MFI:12.14±0.62), SAP group(MFI:0.55±0.07) were significantly higher than those in the patients of control group (MFI:0.3±0.04)(P<0.05). The expression of EMMPRIN levels in the patients of ACS group(MFI:12.14±0.62) were significantly higher than those in the patients of SAP group(MFI:0.55±0.07). The expression of uPA levels in the patients of ACS group (0.92±0.2mg/L) SAPgroup(0.55±0.07mg/L) were significantly higher than those in the patients of control group (0.3±0.04mg/L)(P<0.05). The expression of uPA levels in the patients of ACS group (0.92±0.2mg/L) were ignificantly higher than those in the patients of SAP group(MFI:0.55±0.07)(P<0.05).④. The expression of EMMPRIN levels in the patients of single vessel group (MFI:7.63±0.15), two vessel group (MFI:9.85±0.27), three vessel group (MFI:11.18±0.19) were significantly higher than those in the patients of control group (MFI:5.17±1.27)(P<0.05). The expression of EMMPRIN levels in the patients of three vessel group (MFI:11.18±0.19) were significantly higher than those in the patients of two vessel group (MFI:9.85±0.27) and single vessel group (MFI:7.63±0.15)(P<0.05). The expression of EMMPRIN levels in the patients of two vessel group (MFI:9.85±0.27) were significantly higher than those in the patients of single vessel group (MFI:7.63±0.15)(P<0.05).The expression of uPA levels in the patients of two vessel group (0.73±0.12mg/L), three vessel group (0.89±0.24mg/L) were significantly higher than those in the patients of single vessel group (0.33±0.06mg/L), control group (0.3±0.04mg/L)(P<0.05). but The expression of uPA levels in the patients of single vessel group and control group(0.33±0.06vs0.3±0.04mg/L) had no significant difference (P>0.05).⑤. The expression of EMMPRIN levels in the patients of mild group (MFI:6.35±0.33), medium group(MFI:9.42±0.52), severe group(MFI:12.05±0.21) were significantly higher than those in the patients of control group (MFI:5.17±1.27)(P<0.05). The expression of EMMPRIN levels in the patients of severe group(MFI:12.05±0.21) were significantly higher than those in the patients of medium group (MFI:9.42±0.52) and mild group (MFI:6.35±0.33)(P<0.05). The expression of EMMPRIN levels in the patients of medium group (MFI:9.42±0.52) were significantly higher than those in the patients of mild group (MFI:6.35±0.33)(P<0.05).The expression of uPA levels in the patients of medium group (0.69±0.18mg/L), severe group (0.91±0.31mg/L)were significantly higher than those in the patients of mild group (0.35±0.23mg/L), control group (0.3±0.04 mg/L)(P<0.05). but The expression of uPA levels in the patients of mild group and control group(0.35±0.23vs0.3±0.04mg/L) had no significant difference (P>0.05).⑥. The expression of EMMPRIN levels in the patients of type A group (MF1:6.79±0.22), type B group (MFI:10.62±0.42), type C group(MFI:12.33±0.17) were significantly higher than those in the patients of control group (MFI:5.17±1.27)(P<0.05). The expression of EMMPRIN levels in the patients of type C group(MFI:12.33±0.17) were significantly higher than those in the patients of type B group (MFI:10.62±0.42) and type A group (MFI:6.79±0.22)(P<0.05). The expression of EMMPRIN levels in the patients of type B group (MFI:10.62±0.42) were significantly higher than those in the patients of type A group (MFI:6.79±0.22)(P<0.05).The expression of uPA levels in the patients of type B group (0.71±0.26mg/L), type C group (0.95±0.19mg/L)were significantly higher than those in the patients of type A group (0.32±0.07mg/L), control group0.3±0.04mg/L (P<0.05). but The expression of uPA levels in the patients of type A group and control group(0.32±0.07vs0.3±0.04mg/L) had no significant difference (P>0.05).±. The expression of EMMPRIN levels in the patients of type Ⅰ group (MFI:6.65±1.32), type Ⅱgroup (MFI:11.61±0.81), type Ⅲgroup (MFI:9.47±1.16) were significantly higher than those in the patients of control group (MFI:5.17±1.27)(P<0.05). The expression of EMMPRIN levels in the patients of type Ⅱgroup (MFI:11.61±0.81) were significantly higher than those in the patients of type Ⅲgroup (MFI:9.47±1.16)and type Ⅰ group (MFI:6.65±1.32)(P<0.05). The expression of EMMPRIN levels in the patients of Ⅲgroup (MFI:9.47±1.16) were significantly higher than those in the patients of type Ⅰ group(MFI:6.65±1.32)(P<0.05).The expression of uPA levels in the patients of type Ⅱgroup (0.89±0.17mg/L), type Ⅲgroup(0.56±0.04mg/L) were significantly higher than those in the patients of type I group (0.37±0.06mg/L), control group (0.3±0.04mg/L)(P<0.05). but The expression of uPA levels in the patients of type A group and control group(0.37±0.06vs0.3±0.04mg/L) had no significant difference (P>0.05).⑧The expression of EMMPRIN levels in the patients of Soft plaque group (MFI:11.37±0.76), Fibrous plaque group (MFI:8.93±1.21), Calcified plaque group (MFI:6.94±1.19) were significantly higher than those in the patients of control group (MFI:5.17±1.27)(P<0.05). The expression of EMMPRIN levels in the patients of Soft plaque group (MFI:11.37±0.76) were significantly higher than those in the patients of Fibrous plaque group (MFI:8.93±1.21) and Calcified plaque group (MFI:6.94±1.19)(P<0.05). The expression of EMMPRIN levels in the patients of Fibrous plaque group (MFI:8.93±1.21) were significantly higher than those in the patients of Fibrous plaque group (MFI:8.93±1.21)(P<0.05).The expression of uPA levels in the patients of Soft plaque group (0.97±0.12mg/L), Fibrous plaque group (0.52±0.09mg/L)were significantly higher than those in the patients of Calcified plaque group (0.34±0.12mg/L), control group (0.3±0.04mg/L)(P<0.05). but The expression of uPA levels in the patients of Calcified plaque group and control group(0.34±0.12vs0.3±0.04mg/L) had no significant difference (P>0.05).⑨. To logistic regreeion analyze between CHD and its risk factors,suggested that hypertension,hyperlipidemia,age>60y,male were risk factors for serious coronary artery disesse.Conelusions:1.With the aggravation of coronary artery disease in CHD patients, the activity of EMMPRIN and uPA are increased.2.With the AS plaque stability decline in CHD patients, the activity of EMMPRIN and uPA are increased.3.Both EMMPRIN and uPA are a risk factor for CHD, especially in ACS patients, with the EMMPRIN to increase the level of uPA levelincreased even more significantly,EMMPRIN may be through regulation uPA in the course of the advancement in ACS.4.Combined EMMPRIN and uPA, to raise the accuracy of64-slice spiral computed tomography detection coronary artery plaque in patients with ACS,know stability of the plaque,improve the diagnosis tate.