The Relationship Between High Sensitivity C-reactive Protein And Cystatin C And Ventricular Remodeling After Acute Myocardial Infarction

Objective Acute myocardial infarction is clinically critical,is a common and critical coronary heart disease,IT has a high hospitalization rate,the characteristics of high mortality,serious harm to human health.Ventricular reconstruction after acute myocardial infarction is leading to progressive development of the disease,causing heart failure,malignant arrhythmia and cardiac death and other important factors,Seriously affecting the quality of life of patients with acute myocardial infarction after discharge and long-term prognosis,the burden on society,has gradually become the world's major public health problems.Many studies have shown that inflammation plays an important role in the process of the onset of AMI,but the specific effects of ventricular remodeling after AMI and mechanism is still unclear.In this study,by detecting the serum levels of Hs-CRP and Cystatin C at admission,Combined with echocardiographic parameters at 1 week after admission and at the end of follow-up(12 months).To investigate the correlation between the levels of serum Hs-CRP and Cystatin C and the degree of ventricular remodeling after thefirst AMI,and to provide the scientific basis for the clinical treatment of AMI,disease evaluation and prognosis prediction.Methods In October 2013-2015 in October,the Guangxi Medical University eighth affiliated hospital,Department of Cardiology within 24 hours of onset of hospitalization for the first time confirmed acute ST-segment elevation myocardial infarction in 80 patients,Including anterior wall in 32 cases,extensive anterior wall in 13 cases,24 cases of inferior wall,posterior wall in 11cases;The criteria for AMI were developed and published by the American Heart Association(AHA),the American College of Cardiology(ACC),the European Society of Cardiology(ESC)and the World Heart Federation(WHF).Excluding old myocardial infarction,peripheral vascular or thrombotic diseases,stroke,rheumatic heart disease,thyroid disease,tuberculosis,malignant tumors,acute and chronic infections and other patients;Another 80 cases were selected as the control group,collected relevant clinical data,Serum Hs-CRP,Cystatin C and other biochemical parameters were measured in 24 hours after admission,1 go after admission echocardiogram determination of LVEDD?LVEDV?LVEF,and other indicators.The differences of the parameters between the two groups were analyzed.At the end of the 12-month follow-up review of echocardiography and detailed records of the above indicators,At the end of the12-month follow-up,LVEDV was defined as LVEDV1,1 week after the onset as LVEDV0,According to the results of two supersonic and enchanted the graph calculation left ventricular end-diastolic volume growth delta LVEDV%=(LVEDV1-LVEDV0)/LVEDV0 x 100%.According to the left ventricular end-diastolic volume growth rate of acute myocardial infarction patients were divided into ventricular remodeling group(?LVEDV?20%,n=19)and non-remodeling group(?LVEDV<20%,n=61).The differencesof the parameters between the two groups were compared.With SPSS16.0statistical software for data processing,The measurement data is indicated by mean � standard deviation,and the differences between the measurement data groups were compared by unpaired t test,and chi-square test was used for the count data.Analysis of Hs-CRP and serum CysC level and left ventricular remodeling in various indexes correlation,and the Spearman's method was used.The clinical parameters such as gender,age,Hs-CRP,Cystatin C,CK-MB,blood lipids,hypertension,diabetes mellitus and ventricular remodeling were analyzed by Logistic regression.Inspection level usedBilateral P<0.05.Results(1)The level of serum Hs-CRP was 7.41 � 1.85 mg / L and serum Cystatin C was 1.68 � 0.35 mg / L in AMI group.The level of serum Hs-CRP in the control group was 1.46 � 0.23 mg / L,the serum Cystatin C level was 0.44 �0.12 mg / L;AMI patients serum Hs-CysC and CRP were significantly higher than another group,has statistically significant(P < 0.05,are shown in table 1and figure 1);(2)LVEF of 57.3 � 7.8%,LVEDV of 96.7 � 15.4ml and LVEDD of46.3 � 6.2mm were observed 1 week after the onset of the disease;LVEF 68.2 �9.4%,LVEDV78.4 � 13.2ml,LVEDD40.5 � 3.7mm in the control group;Between the two groups differences comparatived have statistical significance(P < 0.05,table 1 ? figure 1);(3)At the end of follow-up(12months),the patients in the AMI group underwent echocardiography,LVEF48.69�6.53%,LVEDV108.4�14.8ml,LVEDD61.74�8.28mm;Patients in the AMI group were divided into ventricular remodeling group(? LVEDV? 20%)and non-remodeling group(? LVEDV <20%)according to the end-diastolic end-diastolic volume growth rate at follow-up:The ventricular remodeling group:19 cases,12 males and 7 females,age 62.58 � 8.31(41 ~ 78)years.Non-remodeling group: 61 cases,39 males and 22 females,aged 64.92 �9.16(45 ~ 78)years(see Table 2).Between the two groups of age,gender,weight,diabetes,blood lipid,infarction areas,treatment methods(conservative treatment,thrombolysis therapy,PCI)there were no statistically significant difference(P > 0.05,see table 2).The levels of serum Hs-CRP in patients with ventricular remodeling were 9.46 � 1.72 mg / L and 1.98 � 0.33 mg / L respectively.The level of serum Hs-CRP was 4.15 � 1.25 mg / L in non-reconstructed group and 1.32 � 0.21 mg / L in serum.The levels of Hs-CRP and Cystatin C in patients with ventricular remodeling were significantly higher than those in non-remodeling group,Has statistically significant(P < 0.05,table2 and figure 2);The ventricular remodeling group LVEDV128.4 � 13.2ml and LVEDD50.5 � 7.1mm,Non-remodeling group LVEF 59.3�7.8%,LVEDV90.7�15.4ml,LVEDD42.3�5.8mm;Compared to the two groups,difference has statistical significance(P < 0.05,table 2 and figure2).(4)Hs-serum CRP and LVEDD(r = 0.75,P < 0.05),LVEDV(r = 0.58,P <0.05)were significantly positive correlation;And LVEF(r = 0.73,P < 0.05)were significantly negative correlation(table 3,figure 3-5).Serum Cys C and LVEDD(r = 0.48,P < 0.05),LVEDV(r = 0.75,P < 0.05)were significantly positive correlation;And LVEF(r = 0.52,P < 0.05)were significantly negative correlation(table 4 and figure 6-8).(5)To gender,age,Hs CRP,CysC,CK-MB and blood fat,high blood pressure,diabetes and other clinical indicators and ventricular remodeling do Logistic regression analysis,the results show the Hs-CRP and CysC into the regression equation,and other indicators are eliminated,the instructions in this study the Hs-CRP and CysC is associated with ventricular remodeling independently,is a reliable indicator of ventricular remodeling.Conclusions 1,in the acute phase of myocardial infarction,Hs-CPR,serum CysC concentrations have different degree rise,in both early and late myocardial infarction occurred ventricular remodeling;2,The levels of Hs-CPR and CysC in serum were significantly correlated with the degree of ventricular remodeling,suggesting that serum Hs-CPR and Cys C levels were predictors of ventricular remodeling after AMI.Prognosis has a certain clinical significance.