Matrix metalloproteinase levels in acute aortic dissection, acute pancreatitis and other abdominal pain.

BACKGROUND

Acute aortic dissection (AAD) is a life-threatening emergency. Patients with AAD who have abdominal pain are easily confused with patients with surgical acute abdomen. Matrix metalloproteinases (MMPs) play an important role in the pathophysiology of AAD. This study was undertaken to compare serum MMP-9 levels in patients with acute abdomen and those with AAD presenting as abdominal pain in the emergency department.

METHODS

Blood samples were collected within 1 h and 24 h after admission to the emergency department. Serum levels of MMP-9, lipoprotein (a) (LP(a)) and high-sensitivity C-reactive protein (hsCRP) were measured in 20 healthy controls, 20 patients with acute pancreatitis, 20 with other acute abdomen and 20 patients with AAD with abdominal pain by enzyme-linked immunosorbent assay and immunoturbidimetric assay, respectively.

RESULTS

Serum MMP-9, LP(a) and hsCRP levels were significantly higher in the three groups of patients than in the healthy controls, with no significant fluctuation within 24 h of admission in any group. Mean serum MMP-9 levels in patients with acute pancreatitis (768 (95% CI 651 to 885) ng/ml within 1 h; 708 (95% CI 677 to 740) ng/ml at 24 h) were significantly higher than in patients with other acute abdomen (244 (95% CI 182 to 266) ng/ml within 1 h; 259 (95% CI 219 to 299) ng/ml at 24 h) and lower than in patients with AAD (1052 (95% CI 921 to 1183) ng/ml at 1 h; 1107 (95% CI 973 to 1241) ng/ml at 24 h) (all p<0.05). No significant difference was detected in serum LP(a) and hsCRP levels among the three groups of patients.

CONCLUSIONS

Patients with AAD who have abdominal pain have significantly higher serum MMP-9 levels than patients with surgical acute abdomen.