| Objective: To explore the significance of the renin-angiotensin-aldosterone system (RAAS) level in evaluating the severity and prognosis ofacute ST-segment elevation myocardial infarction (STEMI) patients bycomparing the RAAS level in different myocardial infarction area (MIA) andLVEF, BNP, K+, CKMB, cTnI level between different RAAS level in STEMIpatients.Methods: A total of68STEMI patients were enrolled in the experimentalgroup from June2011to March2012, in The second hospital of HebeiMedical University. According to the myocardial infarction size, theexperimental group was divided into small area myocardial infarction group(0%<infarction area≤15%, group A) and large area myocardial infarctiongroup (infarction area>15%, group B). Group A included27cases (21malesand6females, age57.89±11.64years,35-79); group B included41cases (36males and5females, age59.49±13.13years,38-86). Thirty-five patients withunstable angina were selected in the control group (group C) based on thesame exclusion criteria as the experimental group, which included29malesand6females(age57.31±13.68years,35-86). The RAAS levels amongGroup A, B and C were compared and their correlation were analyzed. BothGroup A and B were devided into low-Renin group and high-Renin group, theLVEF, BNP, K+, CKMB, and cTnI levels between low-Renin group andhigh-Renin group were compared in STEMI patients.In all patients, the18leads electrocardiogram, blood pressure, clinicalhistory, myocardial enzyme, troponin I, renal function, electrolyte and BNPwere checked before reperfusion therapy, and the vein blood was collectedafter lying in bed for6hours(including the lying time before admission) for testing the renin-angiotensin-aldosterone system hormones (strict controlmentof the sampling time in24hours after AMI, and in the condition of not takingdiuretics, β-blockers, ACEIs/ARBs, reserpine and steroid after admission).The vein blood was used for the measurement of myocardial enzyme andtroponin I in every2hours within24hours after AMI, and once a dayafterwards. In the second day morning after admission, vein blood was takenfor the routine measurement of liver function, blood lipids, blood glucose,platelet aggregation and coagulation, and the UCG for left ventricular ejectionfraction (LVEF%) when patients were relatively stable. All patients weregiven conventional treatment. Myocardial enzyme, troponin I, renal functionand electrolyte were detected in the biochemistry lab of the second hospital ofHebei Medical University, and BNPs were detected in our division. Theelectrocardiogram ST segment method and Clemmensen formula were usedfor calculating the myocardial infarction area. RAAS were detected byradioimmunoassay. All the data were analyzed with SPSS19.0software. AP-value of less than0.05was considered as statistical significance.Results:1. There was no significant difference among group A, B and C in baselineclinical characteristics (P>0.05), including the age, gender, BMI, the systolicpressure, diastolic pressure, history of hypertension and diabetes, smokinghistory, cholesterol levels, triglyceride levels and sodium concentration.2. Comparision of renin, angiotensinⅡ and aldosterone levels among groups:ANOVA result: there was difference among group A, B and C. Post Hoc Testsresult: the renin level of group B was higher than that of group A (4.502±1.131vs2.927±1.108ng/ml/h, P<0.05); the renin level of group A and group B werehigher than that of group C (2.927±1.108vs0.507±0.167；4.502±1.131vs0.507±0.167ng/ml/h, P<0.05). The angiotensin II level of group B was higherthan that of group A (232.394±102.871vs232.394±102.871pg/ml, P<0.05);the angiotensin II level of group A and group B were higher than that of groupC(232.394±102.871vs53.745±11.656；232.394±102.871vs53.745±11.656pg/ml, P<0.05). The aldosterone levels of group B was higher than that of group A (0.4451±0.0993vs0.3403±0.0929ng/ml, P<0.05); the aldosteronelevels of group A and group B were higher than that of group C(0.3403±0.0929vs0.1104±0.0316；0.4451±0.0993vs0.1104±0.0316ng/ml,P<0.05). The correlation analysis between rennin,angiotensin Ⅱ,aldosteroneand MIA: Spearman parameters regression analysis method, the MIA andrenin, angiotensin Ⅱ, aldosterone was positive correlation (rrenin=0.623,rangiotensinⅡ=0.480, raldosterone=0.644), it was statistically significant (P<0.05).3. Comparision of heart function between L-Renin and H-Renin groups: TheLVEF in H-Renin groups of Group A was lower than that of in L-Renin(54.72±4.66vs60.59±4.64, P<0.05). The BNP level in H-Renin groups inGroup A was higher than that of in L-Renin (287.71±123.73vs193.62±69.50,P<0.05). The LVEF in H-Renin groups of Group B was lower than that of inL-Renin (46.38±10.88vs52.83±7.49, P<0.05). The BNP level in H-Reningroups in Group B was higher than that of in L-Renin (791.65±428.61vs335.52±135.22, P<0.05).4. Comparison of K+level between L-Renin and H-Renin groups: The K+level in H-Renin groups of Group A was lower than that of in L-Renin(3.72±0.49vs4.11±0.47, P<0.05). The K+level in H-Renin groups of GroupB was lower than that of in L-Renin (3.62±0.52vs4.00±0.56, P<0.05).5. Comparison of CKMB and cTnI level between L-Renin and H-Reningroups: The CKMB level in H-Renin groups of Group A was higher than thatof in L-Renin (142.21±51.27vs47.29±20.72, P<0.05). The cTnI level inH-Renin groups in Group A was higher than that of in L-Renin (26.11±12.95vs13.84±8.45, P<0.05). The CKMB level in H-Renin groups of Group B washigher than that of in L-Renin (321.21±151.02vs229.76±104.58, P<0.05).The cTnI level in H-Renin groups in Group B was higher than that of inL-Renin (59.33±26.97vs41.37±20.98, P<0.05).Conclusions:1. The renin, angiotensin II and aldosterone levels are significantly elevated inSTEMI patients of the early stage and have significant positive correlationswith MIA. For the STEMI patients, the higher RAAS levels can be treated as bigger MIA and higher CKMB, cTnI level.2. In STEMI patients, the higher RAAS level, the worse heart function.3. In STEMI patients, the higher RAAS level, the more risky to have a low K+,the more possibilities to occur malignant arrhythmia. |
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