The Relationship Between Hs-CRP, SCD40L, MMP-9, Carotid Atherosclerosis And Acute Coronary Syndrome And The Effect Of Simvastatin Therapy

The relationship between hs-CRP, sCD40L, MMP-9, carotid atherosclerosis and acute coronary syndrome and the effect of simvastatin therapyObjective1. To study the relationship between the serum level of inflammatory factors, carotid atherosclerosis and the coronary atherosclerotic plaque stability and the extent of coronary artery disease.2. To observe the effect of different dose of simvastatin on the inflammatory factors and the atherosclerosis regression in acute myocardial infarction.Method1.45 patients with acute coronary syndrome (23 patients with acute myocardial infarction, and 22 patients with unstable angina pectoris), 22 patients with stable angina pectoris who underwent coronary angiography were enrolled in our study. Meanwhile 18 healthy persons were selected as control. The serum level of hs-CRP, sCD40L and MMP-9 were determined by ELISA, the bilateral carotid IMT and atherosclerotic plaques were measured by B mode ultrasounding, and the coronary artery disease were classified one-vessel lesion, two-vessel lesion and three-vessel lesion. The relationship between the serum inflammatory factors and unstable plaque and the relationship between the carotid atherosclerosis and the extent of coronary artery disease were analysised.2.43 patients with acute myocardial infarction were divided into 2 groups(A, B group). The patients in group A (22 patients) were given orally simvastatin 20mg/d, and the patients in group B (21 patients) were given orally simvastatin 40mg/d. The serum level of hs-CRP, sCD40L, MMP-9 and serum lipid were measured at the end of the 12th week and the 24th week, the carotid IMT and plaque score were measured at the end of the 24th week and the 48th week.Result1. The serum level of hs-CRP, sCD40L and MMP-9 in acute coronary syndrome were increased significantly compared to stable coronary heart disease (P＜0.05), and they correlated each other significantly (P＜0.05); the carotid IMT and rate of detection of plaques was also significantly correlated to the extent of coronary artery disease (P＜0.05).2. In these patients with acute myocardial infarction received simvastatin 20mg/d or simvastatin 40mg/d in early phase, their serum level of hs-CRP, sCD40L and MMP-9 were significantly decreased at the end of the 12th and the 24th week (P＜0.05), and group B(simvastatin 40mg/d) is superior to group A(simvastatin 20mg/d) (P＜0.05). The carotid IMT and plaque score in both groups trended to decrease at the end of the 48th week, and group B(simvastatin 40mg/d) is superior to group A(simvastatin 20mg/d )(P＜0.05).Conclusion1. The serum level of hs-CRP, sCD40L and MMP-9 were increased significantly in ACS patients, It could help to detect and diagnose unstable atherosclerotic plaque.2. The carotid IMT and atherosclerotic plaques might be regarded as a predicative marker for the extent of coronary heart disease.3. When the ACS patients were treated early with simvastatin, the serum level of inflammatory factors were significantly decreased, the progression of athrosclerosis might be inhibited in some extent, and the high dose of simvastatin might be better.