| BackgroundPentraxin-3(PTX-3), a member of C-reactive protein(CRP) superfamily, is a recently discovered acute phase inflammatory protein, which is a pentamer structure of protein containing 382 amino acids. PTX-3 is mainly secreted by the vascular endothelial cells and macrophages induced by inflammatory factors (tumor necrosis factor, IL-I, etc). Recent studies have confirmed that there is PTX-3 expression in the atherosclerotic plaque, suggesting that PTX-3 levels may reflect inflammation of vessels more directly, known as the "CRP" of vascular system. Recently, It was reported by some papers that PTX-3 increased significantly in acute coronary syndromes. Dyslipidemia is a major risk factor for coronary heart disease(CHD). Level of serum pentraxin-3 and blood lipid, hs-CRP in acute coronary syndromes patients needs further study.ObjectiveTo explore the level of serum PTX-3 in ACS patients and its relationship with hs-CRP and lipid levels, and study the prognositic value of serum PTX-3 to ACS and its prognosis.Methods146 patients who were admitted in department of cardiology of the second Xiangya hospital of the Central South University from July 2008 to December 2009 were Collected and analyzed. Patients were divided into two groups, first one is the SAP while the second one is the ACS group. From the hospital medical center, we select 25 cases of healthy adults as normal control group. The serum PTX-3 levels were measured by enzyme linked immunosorbent assay (ELISA), and blood lipid and hs-CRP was tested with quality control by laboratory inspector. Analysis the correlation of PTX-3 and hs-CRP and blood lipid. ACS patients were followed up 3 months to evaluate the effect of serum PTX-3 and blood lipid levels to ACS and its prognosis. All the ACS Patients were divided into two subgroups, first one is the PTX-3 normal group while the second one is the PTX-3 abnormal group.Results1. Serum PTX-3 and total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) levels in acute coronary syndrome were significantly higher than the SAP group and control group, and the difference had statistical significance (6.39±3.01 ng/ml vs 3.87±2.05 ng/ml,2.90±1.94 ng/ml, P<0.01 and 5.00±1.60 vs 4.21±1.50,2.93±0.60, P<0.05); Serum PTX-3 levels in SAP group was not significantly higher than the control group, and the difference had no statistical significance (3.87±2.05ng/ml vs 2.90±1.94 ng/ml, P>0.05), however TC/HDL-C was statistically significant (4.21±1.50 vs 2.93±0.60, P<0.05).2. Serum PTX-3 area under the diagnosis of ACS ROC curve is 0.77 and hs-CRP is 0.65. The sensitivity and specificity of serum PTX-3 were 72.6% and 70.6%. The sensitivity and specificity of plasma hs-CRP was 54.2% and 62.5%.3. In ACS patients, PTX-3 and TG/HDL-C, TC/HDL-C, TQ TC, hs-CRP levels were not related significantly, and the difference was not statistically significant (r=0.14,0.002,0.11,0.02,0.12 P>0.05). It is noteworthy that PTX-3 levels showed significant correlation between HDL-C(r=-0.16, P=0.04) and LDL-C (r=0.23, P=0.01).4. In ACS patients, compared with the normal group, the recent incidence of adverse events in the increased PTX-3 or total cholesterol (TC)/HDL-C group was significantly higher, especially when both were abnormal, and the difference was statistically significant(OR=3.00, P<0.05 and OR=2.71, P<0.05 and OR=6.13, P<0.05).Conclusions1. Comparing the SAP group and control group, PTX-3 levels and TC/HDL-C in patients with ACS were significantly increased, suggesting that PTX-3 levels and TC/HDL-C in serum is related to the unstable plaque. Serum levels of PTX-3 can be used as a new predictor of ACS, and is better than hs-CRP.2. In patients with ACS, elevated serum levels of PTX-3 or TC/HDL-C have a poor prognosis, suggesting that PTX-3 or TC/HDL-C can be used as a predictor of poor prognosis. Combining measurement of PTX-3 and TC/HDL-C may improve the accuracy in identifying the individuals with high risk of recurrent coronary events in secondary prevention of CHD. |
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