Clinical Significance of Markers of Collagen Metabolism in Rheumatic Mitral Valve Disease

BackgroundRheumatic Heart Disease (RHD), a chronic acquired heart disorder results from Acute Rheumatic Fever. It is a major public health concern in developing countries. In RHD, mostly the valves get affected. The present study investigated whether extracellular matrix remodelling in rheumatic valve leads to altered levels of collagen metabolism markers and if such markers can be clinically used to diagnose or monitor disease progression.MethodologyThis is a case control study comprising 118 subjects. It included 77 cases and 41 healthy controls. Cases were classified into two groups- Mitral Stenosis (MS) and Mitral Regurgitation (MR). Carboxy-terminal propeptide of type I procollagen (PICP), amino-terminal propeptide of type III procollagen (PIIINP), total Matrix Metalloproteinase-1(MMP-1) and Tissue Inhibitor of Metalloproteinase-1 (TIMP-1) were assessed. Histopathology studies were performed on excised mitral valve leaflets. A p value ResultsPlasma PICP and PIIINP concentrations increased significantly (p459 ng/mL for PICP provided 91% sensitivity, 90% specificity and a likelihood ratio of 9 in diagnosing RHD. Histopathology analysis revealed inflammation, scarring, neovascularisation and extensive leaflet fibrosis in diseased mitral valve.ConclusionsLevels of collagen metabolism markers correlated with echocardiographic parameters for RHD diagnosis.背景：风湿性心脏病（Rheumatic Heart Disease, RHD）是一种由急性风湿热引发的慢性获得性心脏疾病，在发展中国家属于主要公共卫生问题。风湿性心脏病主要累及心脏瓣膜。本研究旨在探讨风湿性瓣膜的细胞外基质重塑是否会导致胶原代谢标志物水平异常，以及此类标志物是否可用于临床诊断或监测疾病进展。 方法：本研究为一项纳入118名受试者的病例对照研究，包含77例病例与41名健康对照。病例被分为两组：二尖瓣狭窄（Mitral Stenosis, MS）与二尖瓣反流（Mitral Regurgitation, MR）。本研究检测了Ⅰ型前胶原羧基端肽（PICP）、Ⅲ型前胶原氨基端肽（PIIINP）、总基质金属蛋白酶-1（MMP-1）以及基质金属蛋白酶组织抑制剂-1（TIMP-1），并对切除的二尖瓣瓣叶开展组织病理学研究。原文此处关于p值的完整信息存在缺失。 结果：血浆PICP及PIIINP浓度显著升高。当PICP临界值设为459 ng/mL时，诊断RHD的灵敏度为91%、特异度为90%，似然比为9。组织病理学分析显示，病变二尖瓣瓣叶存在炎症、瘢痕形成、新生血管形成及广泛纤维化。 结论：胶原代谢标志物水平与用于RHD诊断的超声心动图参数具有相关性。