The Dynamic Variation Of Serum Resistin Level In Acute Coronary Syndrome Patients And Its Clinical Significance

Objective: The acute coronary syndrome is a group of clinical syndrome induced by acute myocardial ischemia. It is found that the inflammation plays an important role in occurrence and development of ACS. Resistin is a kind of adipocytolines which can activate endothelial cell and enhance the migrating ability of vascular smooth muscle.And it increase the release and expression of many factor,such as endothelin-1,prothrombin activator inhibitor-1,vascular cell adhesion molecule-1(VCAM-1), intercellular adhesion molecule-1 (ICAM-1),making them widely participate in the process of atherosclerotic.High-sensitivity-protein C-reactive(Hs-CRP) is a kind of reactive protein in period of acute inflammatory,which considers as a sensitive and reliable inflammatory marker.The level of Hs-CRP can reacte the load of inflammation in atherosclerosis and the severity of coronary heart disease.Research shows that,Resistin is significantly correlated with Hs-CRP and leukocyte,and it maybe promote unstable plaques'occurrence. Therefore,The further study to resistin and Hs-CRP will contribute to the awareness of atherosclerosis development and provide a new ideas for prevention and treatment of atherosclerosis. This article research that, the dynamic variation of serum resistin and Hs-CRP level and its correlation in acute coronary syndrome patients,the correlation of serum resistin level with the severity of ACS patients and the occurrence of Major Adverse Cardiovascular Events in future,to explore the possibility of resistin as a biological indicator used to monitor the development of ACS and the value of resistin used to assess the sverity of ACS and infer the prognosis of ACS.Methods: 80 patients with thoracodynia diagnosed ACS,who came from the inpatients of 2th hospital affiliated with the HEBEI Medical University(55 males and 25 females), with average age of (54.0±8.1) years,Body Mass Index(BMl)(23.35±0.86)kg/m2 . 30 healthy staffs were recruited as normal control group(19males and 11 females), with average age of (53.9±7.2) years,BMl(23.21±0.78)kg/m2. According to the history and the examination results,the patients with ACS were divided into three groups: 30 patients with ST-elevation myocardial infarction (STEMI)(21males and 6 females), with average age of (53.77±8.45) years,BMl(23.69±0.79)kg/m2 ; 30 patients with non-ST-elevation myocardial infarction(NSTEMI)(20males and 10 females), with average age of (53.77±8.45) years,BMl(23.2±0.88)kg/m2; 20 patients with unstable angina(13males and 7 females),with average age of (53.3±8.05) years,BMI(23.17±0.16)kg/m2.All subjects had excluded that:⑴Merging infectious diseases,such as serious upper respiratory tract infection,lungs and biliary infections,etc.⑵Autoimmune diseases, malignant tumor.⑶Cerebrovascular disease, systemic large-artery disease.⑷Applicating anti-inflammatory drugs,such as steroids antiphlogistic analgesics, steroids and opium drugs,etc.⑸Hepatic and kidney disease and metabolic disease(diabetes, thyroid function hyperthyroidism, hyperlipidemia).⑹operation or wound in the one months.⑺The time of chest pain onset with ACS exceeding 12 hours.⑻Over 80 years of age, BMI≥25kg/m2 and <18.5kg/m2. The age, sex, BMI, blood-lipid and blood pressure showed no difference among three groups. All selected patients were given the ACS standardized treatment,afer conventional acquisition history and laboratory tests. All patients with ACS were taken 4 times ulnar venous blood 5ml on an empty stomach at 12th hour(8-10 hours without food),3th day,7th day and 14th day of chest pain onset.Control group were taken 1 time ulnar venous blood 5ml on an empty stomach. The levels of serum resistin were determined by enzyme-linked immunosorbent assay (ELISA),and the levels of Hs-CRP were ditermined by immune turbidimetric test. All cases were followed up for 6 months, recorded the major adverse cardiovascular events (MACE), including non-fatal myocardial infarction, heart failure, angina pectoris or failure to the hospital,cardiac sudden death.The dynamic changes of serum resistin and Hs-CRP and its correlation were detected.The difference of the resistin peak(at the 3th day) of three groups were detected.The relationship between resistin peak and MACE were analyzed.Results: The levels of serum resistin at 12th hour ,3th day , 7th day and 14th day after chest pain onset with ACS patients were(5.09±1.99)ng/mL, (9.73±2.33)ng/mL,(6.13±1.98)ng/mL and (3.99±1.49)ng/mL. The serum resistin levels at 12th hour,3th day and 7th day were significantly higher than control group (1.93±0.58) ng/mL, the differences had statistical significance (P<0.01). The serum resistin level at 14th day were higher than control group,the difference had statistical significance(P<0.05).And the 3th day serum resistin level were significantly higher than other three moments, the differences had statistical significance(P<0.01).The levels of serum Hs-CRP at 12th hour ,3th day , 7th day and 14th day after chest pain onset with ACS patients were (10.09±2.12)ng/mL,(16.73±3.51)ng/mL, (11.12±2.30)ng/mL and (2.41±1.41)ng/mL.The serum Hs-CRP levels at 12th hour,3th day and 7th day were significantly higher than control group (1.93±0.58) ng/mL,the differences had statistical significance(P<0.01).The serum Hs-CRP level at 14th day were higher than control group,the difference had statistical significance(P<0.05) .And the 3th day serum Hs-CRP level were significantly higher than other three moments, the differences had statistical significance (P<0.01).There were a positive linear correlation between serum resistin levels and serum Hs-CRP levels at the same time of 12th hour,3th day,7th day and 14th day(r=0.464 ,0.627, 0.572,0.470 P<0.05).The level of serum resistin at 3th day were respectively STEMI group(11.48±2.34)ng/m1,NSTEMI group(10.58±2.27)ng/m1,UAP group(8.13±1.61)ng/m1,The difference had not statistical significance between STEMI group and NSTEMI group (P>0.05).Compared to UAP, resistin levels were elevated in patients with NSTEMI and STEMI,The difference had statistical significance, (P<0.01). Compared to UAP group(10%),the incidence of MACE in the 6 months were significantly higher with STEMI group(33.33%)and NSTEMI group (13.33%). The difference of resistin levels had statistical significance between two groups whether with MACE(11.30±2.35ng/ml vs 7.54±2.46 ng/ml,P<0.01). Conclusion: 1. The level of serum resistin and serum Hs-CRP at 12th hour ,3th day , 7th day of ACS onset were significantly raised than control group, the 3th day were the highest, at 14th day were still higher than normal control. With the development of ACS, the levels of serum resistin and serum Hs-CRP have dynamic variation. The level of serum resistin and serum Hs-CRP have a positive correlation, it showed that they may work together in the inflammatory reaction of ACS. 2. The level of serum resistin in the STEMI group and NSTEMI group was significantly higher than NSTEMI group at 3th day, suggested the correlations between the correlation serum resistin level and severity of coronary disease. 3. Compared to UAP group,the incidence of MACE was significantly higher with STEMI group and NSTEMI group in the 6 months,The level of serum resistin of patients with MACE was significantly higher than patients with no-MACE. It demonstrated that the resistin was a negative factor which leaded to the occurrence of MACE and worsened prognosis.