Changes Of Serum Placental Growth Factor Levels During Percutaneous Coronary Intervention And Clinical Significance

Objective:Coronary heart disease(CHD) has become one of the common diseases which affects human health seriously in the whole world. The rate of morbidity and mortality increases steadily year by year. Although we took active measures, including anticoagulant,thrombolysis,intervention and surgery, but some patients still suffered from serious cardiovascular events. So it is important for seeking methods of predicting and interventing cardiovascular events early. Many research revealed that inflammation plays an important role in the occurrence and development of coronary heart disease. Activated inflammatory response cause rupture of unstable atherosclerotic plaque, with consequent platelet aggregation and thrombosis, acute coronary artery stenosis or occlusion, by which leading to the cardiovascular events. Previous researches have demonstrated that some inflammatory biomarkers could regarded as a risk factor in predicting cardiac events in patients with coronary heart disease. Recent investigations have shown that placental growth factor( PlGF), as a proinflammatory factor, promotes monocyte recruitment,macrophage infiltration and triggers intraplaque inflammation, thereby resulting in unstable atherosclerotic plaque progression and plaque rupture. It serves as an independent biomarker of adverse outcome in patients with coronary heart disease. But there is little research about PlGF in patients with coronary heart disease during percutaneous coronary intervension (PCI). And the effect of placental growth factor on clinical prognosis in PCI patients has been researched less. In this experiment, we observed changes of serum PlGF and high-sensitive C reactive protein (hs-CRP) levels before and after PCI. In the same time, the correlation between PlGF and hs- CRP were studied. The postoperative follow-up was 6 months, relationship between serum PlGF levels and incidence of cardiovascular events were observed. Throughout these, we evaluate the short-term predictive value of placental growth factor and provide theoretical evidence for preventing the occurrence of acute cardiac events.Methods: 110 patients with coronary heart disease ( CHD ), who came from the inpatients of 2th hospital affiliated with the HEBEI Medical University. All patients were firstly treated by percutaneous coronary intervention (PCI). 76 males and 34 females, with average age of 56.0±8.79 years. The patients were divided into three groups by the results of coronary angiography: single vessel lesion group (43 cases ), double vessel lesion group (39 cases), three vessle lesion group ( 28 cases). All subjects had excluded: malignant tumors; valvular heart disease; acute or chronic infection; recent trauma or surgery; connective tissue diseases; hematologic diseases; left ventricular ejection fraction<40%. Another 30 healthy people were in control group ( 21 males and 9 females ), with average age of 53.9±7.12 years. They were eliminated coronary heart disease by routine 12 lead ECG,exercise ECG,Emission Computed Tomography ( ECT ) or coronary angiography. There was no statistical difference in age and sex between all CHD and control group. Four mls of ulnar venous blood were withdrawn from CHD group before PCI and on the first, third, 5 th days after PCI respectively. In the control group, blood specimens were taken from vein only once(measurement served as normal control). Then all samples were poured into tube, using centrifugal machine, 3000r/min, centrifuging 15min, and the serum in Eppendorf was preserved in -80℃refrigerator. Serum PlGF were detected by enzyme-linked immuneosorbent assay ( ELISA ), while the levels of hs-CRP were detected by immunoturbidimetric assay (ITA). The serum level of PlGF and hs-CRP were observed before and after PCI.. The relationship between PlGF and hs-CRP was analyzed. The postoperative follow-up was 6 months, cardiovascular events was observed. Throughout these, we study the short-term prognostic value of PlGF on outcomes of patients with coronary heart disease.Results: (1)Comparison of indexes before PCI between CHD group and normal control group: Serum levels of PlGF and hs-CRP in patients with CHD [(13.06±4.05 ) pg/ml ,(5.50±2.78)mg/L)] were significantly higher than those in healthy control group[(9.67±2.55)pg/ml,(3.54±1.01)mg/L (p<0.01)].(2)Comparison of indexes before PCI among single vessel group,double vessel group and three vessle group: The serum PlGF and hs-CRP levels in single vessel group were significantly lower than those in double-vessel group ([11.83±3.95)pg/ml vs(12.93±4.28)pg/ml(;4.42±1.95) mg/L vs(5.25±1.96)mg/L]. The serum PlGF and hs-CRP levels in double-vessel group were significantly lower than those in three vessle group[(12.93±4.28)pg/ml vs (15.11±3.07)pg/ml;(5.25±1.96)mg/Lvs(5.82±1.77)mg/L].(3)Changes of serum PlGF,hs-CRP levels before and after PCI: Serum PlGF levels of CHD patients on the first day after PCI were elevated as compared with those before PCI ( 14.49±3.42vs 13.06±4.05, P<0.01), obviously reached up peak on the 3^rd day(16.44±3.25 vs 13.06±4.05, P< 0.01) and declined on the 5^th day after PCI. Serum hs-CRP levels on the first day after PCI were elevated as compared with those before PCI, reaching up peak(8.17±1.88 vs 5.50±2.78,P<0.01. On the 3^rd day after PCI, serum hs-CRP levels declined(6.64±2.34 vs 5.50±2.78,P<0.01)and returned to normal levels or so on the 5^th day. The trend are same in single vessel group,double vessel group and three vessle group.(4) Correlation between PlGF and hs-CRP: The peak of serum PlGF levels before and after PCI was positively correlated with that of hs-CRP (r=0.816,P=0.001;r=0.216,P=0.023 respectively). (5) The follow-up results: No one case were out of followed . During the follow-up period, angina pectoris recurred in 14 cases, of which 1 received the treatment of PCI again. All of the cases, 5 with one vessel lesion, 5 with double lesion and 4 with triple lesion. The peak of serum PlGF levels were significantly higher before and after PCI in patients with cadiac events than those in patients without cardiac events(P<0.01).(6) The results of logistic regression revealed that LDL[odds ratio(OR)1.944; 95%confidence interval (CI) 1.044 to 5.265; P<0.05], PlGF [odds ratio(OR)4.839; 95%confidence interval (CI) 1.262 to 10.092; P<0.05], hs-CRP[odds ratio(OR)3.464; 95%confidence interval (CI) 1.609 to 5.905; P<0.05] and length of stent [odds ratio(OR)=1.250, 95%confidence interval (CI) 1.165, 10.454, P=0.026 ) might be powerful predictor of cardiovascular events after PCI in CHD patients.Conclusion: 1 The serum levels of PlGF and hs-CRP in patients with CAD were significantly higher than those in healthy control group. The level of serum PlGF is related with severity of coronary artery lesion. Serum PlGF and hs-CRP levels increases with the increasing of the degree of coronary artery lesion. Serum PlGF levels in patients with one vessel lesion were significantly lower than those with double lesion and triple lesion. The levels of serum PlGF are highest in three vessle group.These results indicate that PlGF and hs-CRP maybe take part in the occurrence and development of coronary heart disease. 2 Serum PlGF levels in 3 groups after PCI were elevated as compared with those before PCI, obviously reached up peak on the 3^rd day after PCI and declined on the 5^th day. 3 The peak of serum PlGF level before and after PCI was positively correlated with that of hs-CRP. 4 The peak of serum PlGF before and after PCI is related with cardiovascular events. Elevation of serum placental growth factor levels before PCI could be regarded as an independent risk factor in predicting cardiovascular events in patients with coronary heart disease.