The Serum Levels Changes Of Vaspin And The Effects Of High Dose Atorvastatin On Vaspin After Short-term Intervene In Patients With AMI

BackgroundCardiovascular disease has been one of the serious diseases threatening the health of human being, With coronary atherosclerotic heart disease dominant, Morbidity and mortality were gradually increased sharply in developing countries. Coronary atherosclerotic heart disease is a kind of heart disease because coronary atherosclerotic lead to coronary stenosis or emphraxis, because functionality changes of coronary, at last lead to myocardial inchemia hypoxia or necrosis, which is called coronary heart disease, also known ischemic heart disease. Many scholars study indicate that adipose tissue is an important endocrine organ with high activty and complex metabolic function in recent years. Obese or too much adipose tissue, especially visceral fat was related closely with insulin resistance, hyperglycaemia, abnormal blood lipid, hypertension, thrombosis and inflammation. Different types of cells secrete a variety of bioactive molecules celled cytokines. Many researches show that cytokines plays an extremely important role in the process of atherosclerosis occurrence and development.In recent years, scholars have found a highly expressed adipokine in visceral adipose tissue recently-(visceral adipose tissue-derived serine protease inhibitor, vaspin). Many study show that vaspin was related closely with fat, insulin sensitivity, 2-diabetes mellitus and has extremely important relationship with atherosclerosis, coronary heart disease and other cardiovascular diseases. Now it already had studies on changes of serum vaspin in patients with different types of CHD, many studies have shown that serum vaspin decreased gradually with the increase of the degree of coronary atherosclerosis. But in recent studies, the connection between the change of serum vaspin intervention and the prognosis of patients with AMI has not been reported. Therefore, to investigate the influence of high dose atorvastatin short-term intervene on vaspin levels of patients with AMI and the MACE happening recently.Objective1. Observe the serum vaspin after short-term intensive atorvastatin intervention in patients with AMI.2. Try to figure out the connection between short-term different doses atorvastatin intervention and the change of serum vaspin, and the connection between the MACE happening of patients with AMI after the intervention.Methods1 Study populationThe total of 118 patients with AMI in vasculocardiology, Wuhan General Hospital, Guangzhou Military Command from February 2014 to October 2014. All patients were treated with PCI, were randomized into intensive statin intervention group (n=50) and conventional statin intervention group (n=68), intensive statin intervention group on set be admitted to hospital was given atorvastatin 40mg everynight, after 1 weeks change to 20mg everynight maintenance treatment conventional statin intervention group was given atorvastatin 20mg everynight maintenance treatment. Serum vaspin on admission, mane sequenti,1 week which were measured by enzyme linked immunosorbant assay (ELISA). There were no significant difference between all groups age distribution, gender composition, hypertension, diabetes mellitus, smoking, creatinine, blood lipoid (P>0.05)2 Research methods2.1 Observation of serum indexThe serum vaspin levels in different times, including at admission, mane sequenti and lweek which were measured by ELISA. Compare with intensive statin intervention group the level of serum vaspin at admission、mane sequenti、1 week, Compare with conventional statin intervention group the level of serum vaspin at admission mane sequenti、1 week; And compare with the change trend of serum vaspin in the two groups on three different time points, Analysis of the relationship between the serum vaspin and short-term intensive atorvastatin intervention.2.2 Clinical observation indexThen we followed for three months and recorded the MACE in patients with AMI, including sudden cardiac death, once again revascularization, cardiogenic shock, malignant arrhythmia, heart failure. To investigate the changes of vaspin and the effects of high dose atorvastatin on vaspin after short-term intervene, to study the relationship of the MACE in patients with AMI.3 Statistical AnalysisAll the data were processed and analyzed by SPSS 19.0 statistical software. All measurement data were expressed by mean ±SD (x±s); Categorical data were shown as percentages(%); chi-square test was used in enumeration data. The correlation between vaspin and MACE were expressed as spearman correlation analysis. We considered a two-tailed value of P<0.05 statistically significant different.Results1. The levels of serum vaspin in intensive statin intervention group at different time points in patients with AMI.The levels of serum vaspin at admission, mane sequenti and one week were increased gradually (378.72+35.66 VS 577.67±31.77 VS 1116.32+38.76, P<0.001), The differences had statistical significance. The serum vaspin levels in one week was significantly higher than admission and mane sequenti (P<0.001).2. The levels of serum vaspin in conventional statin intervention group at different time points in patients with AMI.The levels of serum vaspin at admission, mane sequenti and one week were increased gradually (382.11±32.26 VS 475.14±30.89 VS 907.47±42.68, P<0.001), The differences had statistical significance. The serum vaspin levels in one week was significantly higher than admission and mane sequenti (P<0.001).3. The levels of serum vaspin in two groups at different time points.There were no significant difference in serum levels of vaspin at admission among two groups (378.72±35.66 VS 382.11±32.26).The serum vaspin levels at mane sequenti was significantly higher than admission among two groups (577.67±31.77s 475.14±30.89 VS 378.72± 35.66、382.11±32.26, P<0.001), on mane sequenti serum levels of vaspin in intensive statin intervention group were significantly higher than conventional statin intervention group, the difference was statistically significant (P<0.001).The serum vaspin levels at one week was significantly higher than mane sequenti among two groups (1116.32±38.76.907.47±42.68 VS 577.67± 31.77、475.14±30.89, P<0.001), in one week serum levels of vaspin in intensive statin intervention group were significantly higher than conventional statin intervention group, the difference was statistically significant (P<0.001).4. The relationship between serum vaspin and MACE with AMI patients4.1 The patients were divided to two groups according to the incidence of the cardiovascular event during hospital and three months follow-up, the results show that the levels of vaspin were significantly lower in MACE group than non-MACE group in one week (P<0.02).4.2 Spearman correlation analysis showed that the negative correlation between serum vaspin in one week and MACE in patients with AMI (r=-0.26, P=0.005).4.3 Compared with two groups were happened MACE, there were a negative correlation between high dose atorvastatin intervene and MACE (OR=0.327, 95%CI=0.035-3.015).Conclusions:1. The serum vaspin levels at intensive statin intervention group in mane sequenti and one week were significantly higher than conventional statin intervention group, besides to the peak in one week, the levels of serum vaspin have dynamic variation. Revealed intensive statin intervention maybe involved in the elevation of serum vaspin is a link of the process.2. Intensive statin intervention can make serum vaspin gradually increased in patients with AMI, so protect the coronary and promote the atherosclerotic plaque instability, diminish the risk of MACE. Vaspin is protective factors associated with coronary atherosclerosis, maybe the indicator for AMI prognosis.3. During the follow-up period, the levels of vaspin were lower in MACE group than non-MACE group, the negative correlation between serum vaspin and MACE, speculate the low levels of vaspin may be one of the factors of poor prognosis of AMI, intensive statin intervention is a protective factor of MACE.