The Variation And Clinical Significance Of Peripheral Blood Monocyte Subsets In Patients With Acute ST-segment Elevated Myocardial Infarction

Objective To analyze the variation of peripheral blood monocyte subsets in patients with acute ST-segment elevated myocardial infarction(STEMI), and explore the relationship of monocyte subsets with inflammatory reaction induced by myocardial infarction, myocardial infarction area、ventricular remodeling.Method Thirty-six patients with STEMI, who admitted in our department during the period from September,2013to May,2014were enrolled, and another30healthy subjects acted as normal controls in this study. At the fifth day after myocardial infarction, the percentages of peripheral blood monocyte subsets in monocyte were measured by flow cytometry. Other indicators, including white blood cell count (WBC), blood lipid (TG, TC, HDL-C, LDL-C), high-sensitivity C-reactive protein (hsCRP) were detected at the same day. Left ventricular diastolic diameter (LVD)、left atrial diameter (LAD)、left ventricular ejection fraction (LVEF) were examined by echo-cardiography, and the peak value of creatine kinase isozyme MB (CK-MB) and the number of electrocardiography leads with elevated ST segment were recorded.Results1.Compared with in the normal control group, the absolute number of peripheral blood monocytes was significantly higher in STEMI group (P<0.01), the percentage of CD14++CD16-monocyte subset was reduced (P<0.01), the percentages of CD14++CD16+and CD14+016++monocyte subsets were increased (P<0.01and P<0.05) at the fifth day after STEMI;2. There were positive correlations between the percentage of CD14++CD16-monocyte subset and WBC、CRP (r=0.537、0.512, P<0.01), and negative correlations between the percentage of CD14++CD16++monocyte subset and WBC、CRP (r=-0.398、-0.417, P<0.05);3. There was a positive correlation between the quantity of monocyte and the CK-MB peak (r=0.550, P<0.01), There were positive correlations between the ratio of CD14++CD16-monocyte subset and the peak value of CK-MB, LVD(r=0.647,0.355, P<0.01、<0.05); and a negative correlation with LVEF (r=-0.455, P<0.01), negative correlations between the percentage of CD14CD16++monocyte subset and the CK-MB peak, LVD, LAD (r=-0.348、-0.552、-0.366, P<0.05、<0.01、<0.05), a positive correlation with LVEF (r=-0.512, P<0.01).4. Compared with the conventional treatment group, the of CD14+CD16++monocyte subsets was increased (P<0.01); and also with smaller LVD and higher level of LVEF in the emergency PCI group.Conclusion.1. At the fifth days after STEMI, the absolute quantity of monocytes and the percentage of anti-inflammatory CD14+CD16++monocyte subset are significantly increased, but the proportion of pro-inflammatory CD14++CD16-monocyte subset is decreased;2. The variation of the proportion of CD14++CD16-and CD14+CD16++monocyte subsets is closely related to the inflammatory reaction induced by myocardial infarction, myocardial infarction area and ventricular remodeling.3.Monocyte and the monocyte subsets could be considered as new indexes to judge the degree of myocardial infarction, and the prognosis of STEMI.4. Emergency PCI can reduce the proportion of monocyte subset, but increase the proportion of CD14+CD16++monocyte subset, which may be involved to control ventricular remodeling and improve prognosis for the patients with STEMI receiving emergency PCI.