| Objective: Myocardial infarction is one of the mostcommon pathogenies leading to the left ventricular dysfunctionand chronic heart failure (CHF). However, it is very known thatthe poorly cardiac function mainly affects the live of patientswith coronary disease. It's confirmed that left ventricularremodeling (LVRM) is the basically pathogenesis of post-AMIheart dysfunction. Previous study proved inflammation involvesin AMI. Whether inflammation is associated with LVRM,whether anti-inflammation may improve the prognosis ofpatients with AMI by attenuating LVRM, all these need to beconfirmed by basic and clinical study. The aim of this study is totest the hypothesis that there is a relationship betweeninflammation and LVRM during the acute phase of myocardialinfarction, and that the high inflammatory factors levels mayhelp to distinguish the LVRM crisis group, so certain their valuein the evaluation and prognosis of patients with AMI.Methods: The subjects consisted of 64 patients with firstQ-wave AMI (56 men and 8 women; mean age, 59.96±12.08years) who were admitted within 12 hours after symptom onset.The diagnosis of AMI was made on the basis of chest painpersisting for at least 30 minutes, ST segment elevation of morethan 0.2 mV in at least two contiguous leads, elevation of theserum creatine kinase MB isoenzyme (CK-MB) level more thantwice the upper limit of normal, and positive troponin T. Patientswith previous MI, rheumatic heart disease, thyroid gland disease,tuberculosis, malignancy, acute infection were excluded. In allpatients, blood samples were drawn on 72 hours after onset tomeasure the levels of IL-6 and CRP, by means of ELISA andlatex photometric immunoassay respectively. The peak levels ofCK-MB were obtained by a series of measurement. Two weeksafter onset hospital echocardiogram was performed. The data ofLeft ventricular end-diastolic and end-systolic volumes (LVEDV,LVESV) and left ventricular ejection fraction (LVEF) andcardiac aneurysm were obtained. All patients were given routinemedicine and some received coronary thrombolytic therapy oremergency coronary angioplasty. The data of disease history,serum lipid, fasting plasma glucose were noted in detail. TheIL-6 levels of 20 healthy persons (15 men and 5 women; meanage, 54.75±765 years) were measured to determine a thresholdby which all the AMI patients were divided into two groups: lowIL-6 group and high IL-6 group. The data from the two AMIgroups were analyzed using SPSS11.5 software. Values wereexpressed as mean±SD. A value P<0.05 was consideredstatistically significant.Results: The serum IL-6 level of the control group was5.39±1.71 pg/ml. 10 pg/ml was chosen as a threshold to divideall the patients with AMI into two groups: low IL-6 group(IL-6<10 pg/ml) and high IL-6 group (IL-6≥10pg/ml). The lowIL-6 group consisted of 26 patients, 23 male and 3 female, meanage 56.78±12.41 years. The high IL-6 group consisted of 38patients, 33 male and 5 female, mean age 60.92±12.16 years.The age , sex, DM, hypertension, treatment means, infarctionarea between the two groups had no significance (P>0.05).CRP levels in low IL-6 group and high IL-6 group differedsignificantly (4.28±4.22 mg/dl vs. 9.65±6.91 mg/dl, P=0.000). Itindicated CRP level rose with IL-6. The results ofechocardiogram in low IL-6 group were: IL-6 7.07±1.75 pg/ml,LVEF 58.12±9.83%, LVEDV 121.12±17.47ml, LVESV 50.15±16.25ml; the high IL-6 group results were: IL-6 21.89±20.15pg/ml, LVEF 52.29±11.45%, LVEDV 145.29±35.71ml, LVESV70.21±29.06 ml. All these parameters between two groups hadsignificant difference (P<0.05). The proportion of cardiacaneurysm (3.8% vs. 18.4%) had no significance (P=0.178). Theproportion of LVRM differed significantly (19.23% vs. 63.15%,P<0.05). There were significantly positive correlations betweenIL-6 and CRP, LVEDV, LVESV, cardiac aneurysm. Thecorrelation coefficients were respectively 0.534, 0.448, 0.542,0.269 (P=0.000, 0.000, 0.000, 0.000, 0.032). IL-6 correlatednegatively with LVEF (r=-0.349, P=0.005). IL-6 didn't correlatewith peak Ck-MB (r=0.041, P=0.748). CRP had positivelycorrelation with LVESV and cardiac aneurysm (r=0.494, 0.422;P=0.000, 0.000), and had negative correlation with LVEF...
|
PDF Full Text Request