Serum YKL-40 In Patients With Acute ST Segment Elevation Myocardial Infarction

Objective: To observe the changes of serum YKL-40 levels in patients with acute ST-segment elevation myocardial infarction(STEMI),and to explore its correlations with the Gensini score and the recent left ventricular ejection fraction after myocardial infarction.Method: 58 patients with acute ST-segment elevation myocardial infarction within 12 hours from the CCU ward of the second Hospital affiliated to Dalian Medical University from November 2017 to February 2018 were enrolled.24 patients with negative coronary angiography and exclusion of diabetes were selected as the control group(control).All patients with acute myocardial infarction(AMI)underwent coronary angiography and percutaneous coronary intervention(PCI)in the emergency department.The patients were treated with standard therapy.According to the presence or absence of diabetes mellitus(DM),58 patients were divided into 26 patients in AMI group and 32 patients in AMI complicated with DM group.The serum concentrations of YKL-40 were measured in all acute myocardial infarction patients within 24 hours,48-72 hours,more than 96 hours after the onset of chest pain symptoms.The serum YKL-40 concentrations were measured by enzyme-linked immunosorbent assay(ELISA).All hospitalized patients collected fasting blood glucose,glycosylated hemoglobin,blood lipids,liver biochemistry,thyroid function,myocardial markers,hypersensitive CRP,BNP,NT-pro-BNP,renal function,electrolytes,blood routine and other routines in the morning of the second day of admission.For patients with acute myocardial infarction,the coronary Gensini scores were calculated based on the results of emergency coronary angiography to evaluate the extent of coronary artery lesions.All patients with acute myocardial infarction underwent echocardiography on the 5th-7th day of admission and 1 month after discharge to measure left ventricular ejection fraction.The changes of YKL-40 levels in patients with acute myocardial infarction and the correlation between YKL-40 and Gensini score were analyzed.The correlation between YKL-40 and recent left ventricular ejection fraction after myocardial infarction were analyzed.All statistical data were analyzed by SPSS 22.0 statistical software.Results:1 In the AMI+DM group,YKL-40 level was increased within 24 hours after onset of chest pain symptoms compared with AMI group(70.56±21.56pg/ml vs 59.00±18.48pg/ml,P<0.05),and the YKL-40 levels were significantly higher in the two groups than control group(18.61±3.30pg/ml),there was a statistical difference(P<0.01).After 24 hours,the concentration of YKL-40 gradually decreased.The AMI+DM group decreased slowly compared with the AMI group,48-72 hours(32.78 ± 10.78pg/ml vs 27.00 ± 9.24pg/ml,P < 0.05),more than 96 hours(33.00±10.70 pg/ml vs 24.00±9.24 pg/ml,P<0.05).2 The serum concentration of YKL-40 within 24 hours after the onset of chest pain in patients with acute myocardial infarction was positively correlated with the number of white blood cells measured after admission(R=0.404 P=0.002),and positively correlated with glycosylated hemoglobin(R=0.275 P=0.037).3 The serum concentration of YKL-40 within 24 hours after the onset of chest pain in patients with acute myocardial infarction was positively correlated with the coronary Gensini score(R=0.642 P<0.01).4 All patients with acute myocardial infarction underwent cardiac ultrasound 1 month after discharge.According to whether the left ventricular ejection fraction is less than 50%,the patients can be divided into LVEF<50% group(n=17)and LVEF>50% group(n=41).The concentration of YKL-40 within 24 hours after the onset of chest pain in the LVEF<50% group was significantly higher than that in the LVEF>50% group(79.57±20.84 pg/ml vs 55.19±14.29pg/ml,P<0.01).Conclusion:1.The levels of Serum YKL-40 were elevated in patients with acute myocardial infarction,especially in acute myocardial infarction patients complicated with diabetes,indicating that AMI patients complicated with DM had more severe inflammatory response in the acute phase of myocardial infarction.2.The level of YKL-40 within 24 hours after the onset of chest pain was positively correlated with the number of white blood cells,glycosylated hemoglobin and coronary Gensini score.3.YKL-40 levels were associated with recently measured left ventricular ejection fraction after acute myocardial infarction,and high levels of YKL-40 may indicate poor systolic function.