Influence Of Blood Glucose Concentration On The Levels Of IL-6,PDGF Preoperative And Postoperative In Patients With Acute Myocardial Infarction Treated By Primary Percutaneous Coronary Intervention

Acute myocardial infarction (AMI) is that the severe case of coronary heart disease. Taking the teperfusion strategies quickly is especially important. The primary percutaneous coronary intervention (PCI) are the main and effective reperfusion strategy, which can recover the blood supply of the infarcted myocardium quickly and effectively, degrade the mortality of the patients with AMI, improve prognosis of these patients. Although treated by reperfusion strategy, patients with AMI for diabetic or stress hyperglycemia have inferior clinical prognosis and high restenosis rate. Inflammatory play an important part in the forming and developing of artherosclerosis, the development and succession of frail, the disruption of plaque, the prognosis of the patients with AMI and restenosis. IL-6,PDGF are the important inflammatory factor in Inflammatory reaction. The levels of them can reflect the degree of the inflammatory reaction. Previous studies suggest that hyperglycaemia in patients with AMI may enhance inflammatory reaction,influnce the prognosis of patients with AMI. Previous studies investigating the effect of admission glucose levels on levels of the inflammatory factor (especially IL-6,PDGF) preoperative and postoperative in patients with AMI treated by primary PCI are rare reported.Objectives: To observe the effect of admission glucose levels on levels of IL-6,PDGFpreoperative and postoperative and short-term prognosis in patients with AMI treated by primary PCI, to discuss the possible mechanisms of those effect.Methods: 1. Groups: A total of 54 patients with AMI treated with successful primary PCI within 10 hours after onset of symptoms, admitted in cardiovascular medical department and, the first hospital of Jilin university, between October 2006 and January 2008, with complete data, were classification according to plasma glucose levels at admission and with diabetes or nodiabetes: groupⅠ, nondiabetic with blood glucose level<8.0mmol/L; groupⅡ, nondiabetic with blood glucose level≥8.0mmol/L; groupⅢ, diabetic. 2. Sample collection: All patients were drawed blood for 5 ml from ulnar vein preoperative and 24 hour, 48 hour postoperative and put into test tube. Those samples were centrifuged 10 minutes by 3000r/min immediately. Then we take upper stratum blood serum and put it in test tube. Collected samples were preserved in icebox with-20℃waiting for measured together. 3. Measure of blood serum IL-6,PDGF: Using the method of enzyme-linked immunosorbent assay (ELISA) measure levels of blood serumIL-6,PDGF. 4. Statistics analysis: Measurement data are expressed as means±SD ( x±S). Analysis of measurement data use analysis of variance (ANOVA) or rank-sum test. Analysis of numeration data useχ2 test.Dependablity analysis use linear corelation. All statistical analysis were done using SPSS 13.0. Pvalue<0.05 was considered statistically significant.Results: 1. The general clinical setting: There were no difference among three groups in general state of health, exemple for age, sex, creatine kinase, smoking history, hypertensive history, cerebrovascular disease history, however, the TG evels of group III were higher than other groups (There weren't statistics difference, P>0.05); the plasma glucose levels of group III were higher than other groups; There weren't difference in the incidence rates of serious cardiac arrhythmia in operation and heart failure duration of hospital stay group comparison, but the incidence rates in group III and group II were higher than that in group I. 2. The coronary artery process data: The constituent ratio of multivessel disease in group 3 was higher than other groups (P<0.05). 3. The level of IL-6: The level of IL-6 increase with blood glucose level group III >group II> group I ,There were significantly difference (P<0.05). The level of IL-6 24 hour postoperative has been higher than preoperative in three group (P<0.05). The extents of group II,III are higher than group I, and the level of IL-6 48 hour postoperative in group I descend to level of preoperative,the descent in group II,III are slowly. 4. The level of PDGF: The level of PDGF increase with blood glucose level group III >group II> group I,There were significantly difference (P<0.05). The level of PDGF 24 hour postoperative has been higher than preoperative in group III,group II (P<0.05). The level of PDGF 24, 48 hour postoperative has been little higher than preoperative in group I. The level of PDGF in group II has been lower than group III and higher than group I. 5. The dependablity analysis of IL-6 and PDGF: Analysis the dependablity between IL-6 and PDGF, dependablity coefficient is r=0.42, P=0.000<0.001. Regression equation is Y (PDGF)=451.28+15.32X (IL-6), IL-6 positive correlated with PDGF.Conclusions: 1. Patients with both coronary heart disease (CHD) and diabetes have serious coronary artery lesion, more multivessel disease. 2. Stress hyperglycemia in patients with AMI increase levels of Inflammatory,extend the time of Inflammatory. 3. the level of IL-6 and PDGF is in positive correlation. 4.Hyperglycaemia in patients with AMI at admission increase the incidence rates of serious cardiac arrhythmia in operation and heart failure duration of hospital stay. 5,Inflammatory reaction intensified by hyperglycaemia may be one of mechanisms which hyperglycaemia influence arhythmia and outcome of patients with AMI treated with PCI.