Study On The Relation Between The Expression Of The Inflammtional Factors And Ventricular Arrhythm In Patients With Acut Coronary Syndrome

BackgroundHigh incidence of cardiovascular diseases in the world and increasing year by year, nowdays, it is become the first killer for our health which mentioned mainly is the acute coronary syndrome. The Acute Coronary Syndrome is characterize by insufficient supply of the perfusion of coronary which result in the myocardial ischemia which cause a series of clinical symptoms. The syndrome include unstable angina (UA)、ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) which have high mortality if it not be accepted intervention therapies in time. Many studies found that the unstable atherosclerotic plaque is the common pathophilogical basic of ACS.The clinical performance manifestations for the unstable atherosclerotic plaque rupture which contain chest pain、chest distress、short of breath、cold sweat、arrhythmia, even heart arrest lead to death. In addition to lipids and endothelial cells, inflammatory factors also play a very important role in the process of the formation and development of unstable plaques in the coronary artery which is confirmed in a large number of trials and clinical research. This study of inflammatory factors involve CD40ligand (CD40L), tumor necrosis factor (TNF-a), interleukin-6(IL-6), high sensitivity C-reactive protein (hs-CRP), which have play an important role in the process of atherosclerosis. Such as TNF-a, involved in the regulation of lipid metabolism,which also is contributing to the induction of vascular endothelial,fibroblast proliferation and lower the activation of the insulin receptor. Meanwhile, it also could affect the function of endothelial and vascular remodeling, increasing the expression of IL-1, IL-6.Besides, it also plays a role in the development of atherosclerosis (AS) and coronary heart disease (CHD). Other factors such as IL-6involved in formation and rupture mechanism atherosclerotic plaque. The mainly mechanism include six facet as follow:Firstly, Change in the sensitivity of insulin by increasing the glucose uptake, which lead to insulin resistance.Secondly, inhibite the hydrolysis of lipoprotein lipase but to stimulate the hydrolysis of fat, leading to elevated serum triglyceride levels.Thirdly, it can increasing the expression of endothelial cells induced by chemokines and adhesion molecules and promoting infiltration of leukocytes and weaken the ability of endothelial cells to produce endogenous nitric oxide. Forthly, increasing the release of hepatic fibrinogen and has a procoagulantation foe the platelet.Fifthly, incrasing the expression of CRP by foster the synthesis of live, so that patients suffering from CHD at a high risk. These together could cause blood viscosity increasingly in local and procoagulant activity, which also make prople susceptible to the formation of atherosclerosis. Instability of atherosclerotic plaque, the pathophysiological basis of acute coronary syndrome, which they play an important role in the develop process of it. The instability of plaque ruptures result from some stresses such as fatigue, infection. As the same time, it also promotes the release of inflammatory factors. As following,the formation of coronary thrombosis leading to myocardial tissue distal blood supply is severely reduced, the perfusion of the blood doesn’t meet the demand of myocardial tissue, then a series of clinical manifestations such as ventricular arrhythmias, heart failure, shock and other clinical manifestations.Objectives:To evaluate the relation between the expression of inflammatory factors after acute coronary syndrome and ventricular arrhythmia。So these inflammatory factors play an important role in the process of the formation of plaque and plaque rupturement.Methods115patients diagnosed with acute coronary syndrome, who come from Nanfang Hospital, Department of Cardiology. After hospitalized,we perform the disease history, physical examination, routine chest X-ray,12-lead ECG (if necessary, line18-lead ECG), echocardiography, laboratorycheck three conventional blood biochemical preoperative preparation, and underwent coronary angiography in cath lab room. These patients classified into three groups:39cases of group A:unstable angina pectoris (UA), including25males and14females; group B:non-ST-segment elevation myocardial infarction group (NSTEMI)22cases, including12males and10females; in group C:ST segment elevation myocardial infarction group (STEMI) in54cases, including30males and24females. Admitted to hospital immediately and then save the blood samples, measure the concentrarion of CD40ligand (CD40L), tumor necrosis factor (TNF-a), interleukin-6(IL-6), high sensitivity C-reactive protein (hs-CRP) in other time. All process of performance in line with the reagents, ELISA was used to test these inflammatory factors. Meanwhile, perform ECG and ECG monitoring and Lown classification according to arrhythmia. The result analysis and Statistical analysis through software SPSS13.0. The measurement data were expressed as mean±standard deviation. the patient’s ventricular arrhythmias classification according to ECG or ECG monitoring. Finally, to explored the relationship between inflammatory factors and ventricular arrhythmias. Calculate the odds ratio (odds ratio, OR) and95%confidence interval (95%confidence interval, 95%CI).(P<0.05) difference was statistically significant.ResultsThere is not statistically significant in three groups among the sex, age, heart rate and blood pressure. The expressions of inflammatory factors in patients diagnosed with ST-segment elevation myocardial infarction are higher singnificantly than other two groups except CD40L which is highest expression in NOT ST-segment elevation myocardial infarction group (p<0.05). In the same time, we found that a positively relation between all Inflammatory factors involve in this study and ventricular arrhythmia classified acoord the Lown criterion (p<0.05).6of these patients died of malignant arrhythmia; this study also found that of CD40L was significantly higher than other patients.ConclusionThe expression of the inflammatory factors in patients with acute coronary syndrome than healthy people, which is relation with the sort of ACS. Meanwhile, there has a higher incidence of ventricular arrhythmia in patients in higher expression of inflammatory factors,so we could draw a conclusion that a higher expression of inflammatory factors is contribute to the induction of ventricular arrhythmia and a positive relation between them.