The Expression And The Clinical Significance Of Plasma Stweak In Patients With Coronary Heart Disease

【Introduction】Coronary heart disease is caused by coronary atherosclerosis, whichresulting in chronic myocardial ischemia, cardiac structural change,dysfunction and energy metabolism failure. The pathological process ofcoronary heart disease including coronary endothelial injury, lipiddeposition, lipid plaque formation. If the plaque ruptured then thrombosisdevelop and block the vessel, causing acute ischemic and myocardialnecrosis, resulting in acute coronary syndrome(ACS). Numerous studieshave demonstrated that inflammatory factors involved in the formation anddevelopment of CHD, thus they are even of indispensable clinical value tothe diagnosis of CHD.Tumor necrosis factor-like weak inducer of apoptosis(TWEAK) is annew member of the TNF superfamily. It is a kind of Ⅱ membrane proteins,and it becomes soluble TWEAK (sTWEAK) under the action of proteolyticenzymes and then secreted to extracellular, binds to and interacts with itsreceptor Fn14, leading downstream biochemical reactions. TWEAK/Fn14axis plays an important role in the process of cell apoptosis, proliferation,angiogenesis and inflammation. In recent years, studies found that TWEAKplays a multiple role in the formation and development of CHD. While studies determined that sTWEAK decreases in stable coronary heartdisease but increases in acute st-elevation myocardial infarction (STEMI),how it is like in other types of ACS has not been reported. Our researchaim to investigate the clinic value of sTWEAK of diagnosis of CHD byexamining plasma sTWEAK concentration in patients with different typesof coronary heart disease (CHD).【Objective】To determine the concentration of soluble tumor necrosis factor-likeweak inducer of apoptosis （sTWEAK） and high-sensitive C-reactionprotein（hsCRP） in patients with acute coronary syndrome（ACS） andinvestigate the relationship between sTWEAK，hsCRP and ACS,and theirclinical significance.【Methods】A total of62patients with ACS (47males and15females,66.06±9.89years old) treated in Department of cardiovascular diseases, the FirstAffiliated Hospital of Chongqing Medical university from September1st2012to March31st2013were involved in this study;19patients withstable angina pectoris（SAP）confirmed by coronary angiography or CTwere also analyzed;29patients without coronary heart disease（CHD）inthis period served as control group. The62ACS patients were divided into3subgroups: ST-segment elevation myocardial infarction(STEMI)group(n=11),non ST-segment elevation myocardial infarction (NSTEMI）group(n=14) and unstable angina pectoris (UAP） group(n=37). ThesTWEAK was measured by enzyme-linked immunosorbent assay (ELISA）while hsCRP was determined by immunoturbidimetry.The concentrationsof sTWEAK and hsCRP were compared among ACS, SAP and controlgroups and also among the subgroups of ACS. The correlation between sTWEAK and hsCRP,cTn,were analyzed and sTWEAK and hsCRP werecompared between ctriple vessel disease and non-triple vessel disease inACS groups.【Results】1. The sTWEAK concentration in ACS(139.95（IQR：121.30-155.51）ng/L)was significantly higher than that in SAP group(93.21（IQR：84.37～114.08）ng/L) and control group(124.24（IQR：118.32-135.49）ng/L)(P=0.000,P=0.007),and it was lower in SAP group than in controlgroup(P=0.007).2. The hsCRP concentration was significantly higher in ACS group(2.29（IQR：0.84-9.77）mg/L) than that in SAP group(1.40（IQR：0.47-1.96）mg/L) and control group(0.87（IQR：0.46-1.75）mg/L)(（P=0.015，P=0.001）,and there was no significant difference beween SAP and controlgroup（P=0.62）.3. There was no statistical difference in sTWEAK level among the3subgroups of ACS patients（P=0.41）. The hsCRP concentration in STEMIsubgroup was higher than that in UAP group(P=0.001), but no significantdifferences were found between STEMI and NSTEMI（P=0.202）.4. There was no linear correlation between sTWEAK and hsCRPconcentration（P=0.462）while hsCRP and cTn were positively correlated（r=0.578,P=0.000）,and there were no difference in the sTWEAK norhsCRP concentration between triple vessel disease and non-triple vesseldisease. 【Conclusion】1. The patients with ACS have higher sTWEAK and hsCRP concentrationswhen compared with SAP and non-CHD, which shows that sTWEAK andhsCRP may be helpful biochemical markers in the diagnosis of ACS.2. Serum hsCRP is positive related with serum cTn in patients with AMI, thatit may have something to do with the determination of the degree ofmyocardial necrosis.