Effect Of Different Dose Atorvastatin On The Concentration Of Serum High Mibility Group Box1in Acute Myocardial Infarction Patients During PCI Perioperative Period

Objective:To observe the effect of different dose atorvastatin on serum high mobility group box1(HMGB1) before and after percutaneous coronary intervention (PCI) in patients with ST-segment elevated myocardial infarction (STEMI).Methods:Seventy normal people and one hundred and twenty-nine acute ST-segment elevated myocardial infarction (STEMI) patients were enrolled. The STEMI patients were treated randomly with lower-dose atorvastatin (lower-dose group,63patients,20mg30min before PCI, then20mg QN till30days after patients’ discharge) or high-dose atorvastatin (high-dose group,66patients,80mg30min before PCI, then40mg QN till30days after patients’discharge). Control group,70patients with no atorvastatin and the stenosis of the coronary artery is less than50%according to coronary angiography. Vein blood was drew from the control group on the second day after coronary angiography. Vein blood was drew at admission from the STEMI patients, and again on the second day and fifth day after PCI. The concentration of serum HMGB1was measured by using enzyme linked immunosorbent assay. The GRACE risk score were used for risk assessment. Analyze the relationship between HMGB1and GRACE risk score as well as risk stratification in patients with STEMI. The STEMI patients was divided into high, medium and low risk group. Collected the baseline characteristics and operation data of all patients, and made a telephone follow-up1year after patients’discharge, which included clinical diagnosed muscle damage and liver damage, postinfarction angina pectoris, recurrent myocardial infarction, a second revascularization, cardiac death, and death of other reasons. SPSS17.0was used for statistical analysis. Chi-square test was used to analyze enumeration data. Measurement data were presented as mean values±SD, and t-tests were used to compare the mean values. Analysis of variance was used between groups. The repeated measurement F test was used for the repeated measurement data. SNK method was used for the comparisons between multiple mean. The relationship between HMGB1and GRACE was analysed by Pearson Correlation. Differences were considered statistically significant at p<0.05. Results:1. STEMI patients’plasma concentrations of HMGB1at admission was (32.00±11.59)ng/ml and on the second and fifth day after PCI were (65.99±23.32)ng/ml and (63.51±24.36)ng/ml respectively, and all were higher than that of normal control people (25.98+6.41)ng/ml (all p=0.000). STEMI patients’plasma concentrations of HMGB1on the second and fifth day after PCI were higher than that at admission.2. There was no difference of plasma concentration of HMGB1between the two different dose groups of STEMI patients at admission (31.51±11.43ng/ml vs32.47±11.82ng/ml, p=0.640), but the second day and fifth day after the operation, plasma concentrations of HMGB1of high-dose group were much lower than those of lower-dose group (the second day:61.49±19.57ng/ml vs70.73±26.01ng/ml, p=0.024; the fifth day:57.19±20.29ng/ml vs70.13±26.58ng/ml, p=0.002).3. There was positive correlation between plasma concentrations of HMGB1and GRACE (r=0.623, p=0.000). The HMGB1concentrations of high risk group, medium risk group, lower risk group were43.17±13.27ng/ml,32.20±10.69ng/ml,27.20±7.65ng/ml. The HMGB1concentration of high risk group was higher than the HMGB1concentrations of medium risk group and lower risk group. The HMGB1concentration of medium risk group was higher than the HMGB1concentrations of lower risk group.4. A telephone follow-up was made in1year after the STEMI patients discharge. Twenty patients admitted to the hospital again. The readmission rate between the two different dose groups had no difference. The serum concentration of HMGB1and GRACE risk score of the rehospitalized STEMI patients in the first year was higher than the non-rehospitalized patients. The rehospitalized STEMI patients were older and had lower LVEF, higher rate of left anterior descending artery as infracted-artery. There was no difference of rate of diabetes, rate of using IABP, concentration of creatine kinase-myocardial band peak and B-type brain natriuretic peptide between the rehospitalized STEMI patients and the non-rehospitalized patients.Conclusion:1. The concentration of serum HMGB1of patients with STEMI are higher than normal level, and that elevate after PCI, which was related with the course of STEMI disease.2. Compared with lower-dose atorvastatin therapy, high-dose atorvastatin can obviously repress the abnormal elevation of serum HMGB1during PCI perioperative period in patients with STEMI.3. The concentration of serum level of HMGB1contributes to rapid assessment on the severity of the patients with STEMI.