| Although great progress has been made in diagnosis and prevention of cardiovascular diseases in recent years, the morbidity and mortality in acute myocardial infarction remains high in the worldwide, which become a serious problem threating to human health. Presently, the clinical diagnosis and monitoring of myocardial injury is mainly dependent on serological biomarkers, such as Creatine kinase, Creatine kinase-MB, Aspartate aminotransferase, Lactate dehydrogenase, Myoglobin and Troponin et. But some enzymes, such as CK and CKMB, are not specific to the heart muscle, which can easily lead to false positive diagnosis. MYO appears early but lack of specificity. CTn I has higher sensitivity and specificity compared to other indicators, but the increase is relatively late which may delay the diagnosis. Therefore, to explore the biological markers with better accuracy and sensitivity are necessary. Some researchs found that the a transcription factor- Hypoxia inducible factor-1α can promote the survival of cells in a hypoxic environment, which increased significantly in AMI patients and it is positively correlated with the area of myocardial infarction. However, whether HIF-1α can be used is an early diagnostic indicator of myocardial infarction is unknown. Objective:The purpose of this study is to detect and analysis of the serum HIF-1α and myocardial injury markers in patients with acute S-T elevation myocardial infarction, and evaluation the value of HIF-1α in the early diagnosis of myocardial infarction and the possibility of its clinical application. Methods:We select the patients with acute chest pain and admitted to hospital within 3h between 2014 November and 2015 January from the second hospital of Shanxi Medical University. Based on coronary angiography and electrocardiogram examina-tion the patients were divided into three groups:AMI group(n=30),Patients with angina pectoris were AP group(n=30), normal population were set to N group(n= 25). All the selected groups were based on data collection.The serum level of CK, CKMB, MYO, CTn I,NT-pro BNP and HIF-1α were analyzed by automatic biochemicaler, chemiluminescence and ELISA kit respectively. The expression levels of HI F-1α and myocardial injury markers were compared in each group, the correlation between HIF-1α and myocardial injury markers in AMI group were analyzed. ROC curve was used to evaluate the value of HIF-1α in the diagnosis of AMI. Results:1. Comparison the results of general data: there were no significant differences in age, sex, blood glucose,liver kidney function,blood lipid, smoking history, history of hypertension among all groups(P>0.05), suggesting that the groups were comparable.2. Measurement results of serum myocardial markers:compared with the N group and the AP group serum MYO,NT-pro BNP in AMI 0-3h group was higher(P<0.01,P<0.05);The content of CK, CKMB, NT-pro BNP, CTn I and MYO in AMI 3-6h group were significantly higher than that in N group and AP group(P<0.01).There was no statistical difference of AST between the different groups.3. Determination results of Serum HIF-1a levels:serum content of HIF-1a in AMI 0-3h group(175.61±70.67) pg/ml, 3-6 h group(373.26±193.51) pg/ml) were significantly higher than those in group n(67.72±11.14) pg/ml(P < 0.01) and AP group(106.35±33.45) pg/ml(P < 0.01);4. Pearson correlation analysis results: AMI 0-3h group, the serum levels of HIF-1a content was positively related with Myo and NT-pro BNP, the correlation coefficient were(r=0.461,r=0.367,P<0.05);AMI 3-6h group, the expression of HIF-1a was positively correlated with MYO, NT pro BNP,CKMB, correlation coefficient(r=0.634,r=0.572,r=0.577,P<0.01)respectively, the correlation coefficient of CTn I and CK were(r=0.404,0.362,P<0.05);5. Receiver operating characteristic curve(ROC) : Area under the curve(AUC) was used to evaluate the predictive power of HIF-1α for AMI. N group and AMI group for the analysis of the crowd.AMI 0-3h group HIF-1a AUC was 0.898(95%CI:0.818-0.986, P < 0.01),The sensitivity in the diagnosis of AMI was 80.7%, specificity 83.3%; AMI 3-6h group HIF-1a AUC was 0.936(95%CI:0.873-0.997, P < 0.01), when the cutoff value of HIF-1α was set as 140.9pg/ml, YONDEN index(sensitivity + specificity-1) up to 0.765,AMI diagnosis sensitivity and specificity were 86.7%, and 88.9%. Conclusion:1. The HIF-1α levels in sera were significantly increased in patients with acute myocardial infarction, which is associated with the degree of myocardial ischemia;2. The HIF-1α levels in sera were positively correlated with other myocardial injury markers after myocardial infarction, suggesting that HIF-1α can be used as an indicator reflecting the extent of myocardial injury;3. ROC curve evaluation further confirmed the diagnosis value of HIF-1α suggesting that HIF-1α is a potential diagnostic marker of AMI. |
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