| Background:Coronary Heart Disease(Coronary heart disease, CHD) is a common and frequently encountered disease that threatens human health seriously and its incidence and mortality is still increasing year by year. Acute myocardial infarction is a severe form of coronary heart disease. In clinical, we found that about 25 percent of patients with myocardial infarction did’t have typical clinical symptoms in the early stages, therefore to diagnose early and assess severity of these patients is important.Arginine vasopressin(AVP) is a sensitive indicator of the hypothalamic- pituitary- adrenal axis activation level.It has a circulating regulatory effect on contracting blood vessels, increasing blood pressure, antidiuretic and all that. It is also involved in the body’s stress response. It is not only one of the neuroendocrine medium in the occurrence and development of cardiovascular disease, but also a significant marker that can reflect the severity and prognosis of critical illness. Copeptin is a part of the C-terminal of pre-provasopressin, which is relatively stable in the body and easy to determine. In the normal population and patients with a variety of cardiovascular diseases,there is significant correlation between copeptin and AVP. Copeptin is expected to be an early warning sign of many diseases.It has been found in recent studies that copeptin may have great value in the diagnosis and prognosis of cardiovascular disease.Objective: To discuss the relationship between human serum copeptin level and the early diagnosis,condition assessment and short-term prognosis of acute myocardial infarction.Methods:We selected 72 patients who visited Department of Cardiology,the Second Hospital of Ji lin University from october 2015 to december 2015 and were diagnosed as acute myocardial infarction by coronary angiography(CAG) or related laboratory tests as AMI group, of which there are 53 males and 19 females aged 34 to 85 with an average age of 62.03 ± 11.27.Meanwhile,26 patients with unstable angina, aged 40 to 76,were selected in UA group and there are 16 males and 10 females, with a mean age of 60.12 ± 8.62. In the control group, there are 25 patients(14 males and 11 females, aged 40-79 years old, mean age 58.36 ± 11.93) who visited our hospital over the same period and underwent coronary CT or CAG prompting coronary artery stenosis <50%. The patients with AMI is diagnosed by the diagnostic criteria for myocardial infarction in 2007, recommended by the global uniform definition in acute myocardial infarction. All enrolled patients with insipidus, acute heart failure,severe infection, acute cerebral infarction, pulmonary hypertension, chronic pulmonary heart disease, severe liver and kidney dysfunction, cancer and so on were excluded. Except for 3 patients who did not undergo coronary angiography,the 69 patients with AMI, according to the results of coronary angiography,were divided into single-vessel disease group(20 cases), 2 branch lesions group(21 cases), 3 branch lesions group(28 cases); on the basis of Gensini scoring system,the patients with AMI were divided into ≤40 group(18 cases) and> 40 group(51 cases). The 72 patients with AMI were followed up for one month and according to the presence or absence of major adverse cardiac events,they are divided into group with MACE and non- MACE group(Angina after myocardial infarction was 26 cases, no post-MI angina group was 46 patients; 24 cases of heart failure after myocardial infarction, 48 cases of myocardial infarction without heart failure; deaths group 7 cases, survival group 65 cases).Patients’ clinical data were collected, including blood pressure, blood lipid, myoglobin, troponin I, copeptin, NT-pro BNP, high-sensitivity C-reactive protein(hs-CRP), creatine kinase(CK-MB), major adverse cardiac events(MACE) within one month after AMI.Results: 1) There was no significant statistical difference between AMI group, UA group and the control group in age, sex, systolic blood pressure, diastolic blood pressure, triglyceride(TG), creatinine, history of diabetes and hypertension, etc(P> 0.05). The TC, LDL-C level in AMI group and UA group was significantly higher,and HDL-C level was lower than control group, which has statistically significance(P <0.05), and the difference of TC, LDL-C and HDL-C between AMI group and UA group was not statistically significant(P> 0.05). The c Tn I, myoglobin, NT-pro BNP, CK-MB and hs-CRP levels in AMI patients were obviously higher than UA group and control group(P <0.05), and differences were no significant between the two latter(P > 0.05). The serum copeptin level in AMI group[(16.17±4.24)pmol/L] was distinctly higher than the UA group[(11.57±2.77) pmol/L] and control group [(9.60±2.73) pmol/L] and the UA group was also significantly higher than control group,of which both had statistically significant difference(P <0.05).2) During 3 hours after chest pain occurs, the serum copeptin, myoglobin and c Tn I level of AMI patients was significantly higher than control group(P <0.05),but CK-MB level had no significant difference compared with control group(P> 0.05). 3) Serum copeptin level in 2 branch lesions group and 3 branch lesions group was significantly higher than single-vessel disease group and control group(P <0.05),while 3 branch lesions group had no statistically significant difference with 2 branch lesions group(P> 0.05).The c Tn I, CK-MB level of each group had no significant difference(P> 0.05).4) Serum copeptin level in group with Gensini score> 40 was significantly higher than group with Gensini score ≤40 and the difference had statistically significance(P <0.05). Pearson correlation analysis showed that copeptin level was positively correlated with Gensini score(P <0.05). The hs-CRP, c Tn I, CK-MB and NT-pro BNP level between the two groups was not statistically significant. 5) Copeptin and NT-pro BNP level in patients with heart failure after myocardial infarction was significantly higher than that without heart failure(P <0.05). 6) Serum copeptin level and Gensini score of death group were both significantly higher than survival group(P <0.05),while the c Tn I,CK-MB and NTpro BNP between the two groups had no significant difference( P> 0.05).Conclusion: 1) Copeptin is obviously higher in the early acute myocardial infarction and combined detection of copeptin and cardiac troponin is conducive to the early diagnosis of acute myocardial infarction. 2) To some extent, serum copeptin may reflect coronary artery disease degree, and better than hs-CRP, c Tn I, CK-MB and NT-pro BNP. 3) Copeptin has some predictive value on recent MACE after AMI. |
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