The Clinical Application Value Of Serum Ferritin And ADMA In Acute Coronary Syndromes

Objective :To investigate the relationship of serum ferritin(SF) and asymmetric dimethylarginine(ADMA) of acute coronary syndrome(ACS) Methods consent.Objects and Methods:1.1 ObjectACS group(n=287) was divided into unstable angina(UA) subgroup(n=182), Including 94 male, 88 females age 43~81( 61.11±11.36) non-ST-segment elevation myocardial infarction(NSTEMI) subgroup(n=38),Including 18 male,20 females age 63~88(74.83±9.51)and;(STEMI) subgroup(n=67) Including 35 male,32 females age 56~84(69.88±7.48)according to clinical data, coronary angiography and electrocardiogram examination. The normal coronary patients provided as control group(n=83) age 46~71(57.44±7.11).1.1.1 Inclusion criteriaAll patients with acute coronary syndrome(ACS) were selected as objects with chest pain seizure(within 48 hours) in first diagnosis, and with no previous history of acute coronary syndrome. Patients in hospital all signed the informed consent.1.1.2 Exclusion CriteriaAcute and chronic infectious diseases, serious blood diseases, liver and kidney function failure, after bone marrow transplantation, rheumatic valvular heart disease, serious trauma or tumor, autoimmune diseases and other effects of the inflammatory markers of disease were excluded.1.2 Methods1.2.1 Specimen CollectionAll subjects admitted to hospital were taken fasting venous blood 5 ml in the next morning. Anticoagulant blood was aside for an hour, then centrifuged for 20 minutes(3000 r.p.m.). Separated serum was preserved in-70 refrigerator, and detected in mass.℃1.2.2 Inspection MethodsSerum Ferritin(SF) and C reactive protein(CRP) were detected by Beckman Coulter unicel DXI 800 automatic immune analyzer and Immage 800 double optical diameter immune turbidimetry respectively. Beckman Coulter automatic chemical luminescence analyzer detected high density lipoprotein(HDL), low density lipoprotein(LDL), glycerin three esters(TG), serum total cholesterol(TC). Cardiac troponin T(c Tn T) was detected by Roche Cobas E601 chemiluminescence analyzer, non-symmetrical dimethyl arginine(ADMA) was detected by Xin Le ADMA ELISA kit.High density lipoprotein(HDL), low density lipoprotein(LDL), triglyceride(TG), serum total cholesterol(TC) were detected by end-point colorimetry. Ferritin(SF) was detected by chemiluminescence immunoassay. C-reactive protein(CRP) was detected by immune turbidity method. TNT was detected by electrochemical luminescence method. ADMA was detected by enzyme linked immunosorbent(ELISA) experiments. All reagents were supporting reagent of Beckman Coulter or Roche original biochemical and immunological analysis system.1.2.3 Diagnostic CriteriaACS diagnosis was according to standard developed by Heart Association(ACC) in USA. UA diagnosis referenced to “the unstable angina pectoris diagnosis and treatment recommendations ". NSTEMI and STEMI diagnosis referenced to “acute myocardial infarction diagnosis of and guidelines for the treatment”.1.3 Statistical TreatmentAll data were analyzed by SPSS statistical software, and mean + standard deviation(+ s) represented measurement data. Normal distribution data between two groups was compared by t test compare, while Skewness distribution data was compared by variance analysis. Mutual relationship analysis between two variables was performed by Spearman correlation analysis. P < 0.05 represented for significant differences. Analysis of specificity and sensitivity of ACS severity were performed by receiver operating characteristic curve(ROC curve) analysis.Results:SF in ACS patients increased significantly compared with the control group(P < 0.01). SF concentration levels in AMI groups was significantly higher than in UA group(P = 0.0021), while there was no significant difference between NSTEMI and STEMI(P=0.1470).SF concentration of different groups was correlated with classical myocardial markers TNT and CRP(The correlation coefficient between SF and TNT, CRP was 0.324, 0.345 respectively). SF was also correlated with HDL(The correlation coefficient between SF and HDL,-0.295(P = 0.014), 0.141(P = 0.106) respectively.)Analyzed by ROC curve, under the curve area of SF was 0.664 compared with control group, and the cut-off value, sensitivity(SEN) and specificity(SPE) was 198.99ng/ml 0.669 and 0.566 respectively, when maximum Youden index was 0.235. Under the curve of SF was 0.609 compared with UA group, and the cut-off value, Sen and Spe 235.08ng/ml, 0.648, 0.51 respectively, when maximum Youden index was 0.159.ADMA concentration level of ACS patients was significantly higher than the control group(P < 0.001) and the UA group(P=0.0158) relatively. Similarly, ADMA levels of NSTEMI group are significantly higher than STEMI group(P=0.0100).ADMA concentration of different groups were all correlated with classical myocardium marker TNT(correlation coefficient between ADMA and TNT was 0.357, P = 0.004),while not correlated with relevant inflammatory factors and other risk factors(CRP, HDL, LDL, TG, TC) of coronary heart diseases(CRP r=0.138 P=0.078:; HDL r=-0.175 P = 0.214; LDL r0.186 = 0.285. TG r = 0.134 P = 0.142, TC r=0.123 P = 0.197). Analyzed by ROC curve, under the curve area of ADMA was 0.751 compared with control group, and the cut-off value, SEN and SPE was 17.98 μg / L, 0.533, 0.880 respectively, when maximum Youden index was 0.413. Under the curve of ADMA was 0.586 compared with UA group, and the cut-off value, Sen and Spe 18.75μg/ml, 0.581, 0.555 respectively. when maximum Youden index was 0.159.After ROC curve analysis between NSTEMI group and STEMI group,under the curve area of ADMA was 0.753, and the cut-off value, SEN and SPE was 21.56 μg / L 0.816 and 0.727 respectively, when maximum Youden index was 0.543.ADMA was correlated with SF relatively(correlation coefficient was 0.294, P=0.043). analyzed by paired fourfold table test, Sen=82.23%,Spe=50.60%,PPV=85.20%,NPV= 44.09%respectively in parallel detection of SF and ADMA in the diagnosis of ACS, and was Sen=38.33%,Spe=95.18%,PPV=96.49%,NPV=30.86% respectively in tandem.Conclusions:1 SF significantly increased in ACS patients, and was correlated with the severity of ACS, even with CRP, disorder of lipid metabolism closely. the detection of SF will contribute to clinical ACS classification and risk stratification.2. ADMA level was significantly increased in patients with ACS, and positively correlated with the severity of ACS. However, there was on obvious correlation between risk factors of coronary heart disease(TC, TG, HDL, LDL) and ADMA. Therefore, ADMA levels are believed to be the independent risk factors of coronary heart disease, and have certain value of diagnosis and differential diagnosis in ACS and its clinical subtypes.3. Combined detection SF and ADMA can exclude a series of diseases which can change inflammatory factors and impair diagnostic performance of individual test, thus improving diagnostic performance in ACS compared with individual test.