| Objective Endothelial cell specific molecule-1(ESM-1) is a novel biomarker of endothelial dysfunction,closely related to atherosclerosis. Stress hyperglycemia is accompanied by endothelial dysfunction and inflammation may be involved in the pathogenesis of stress hyperglycemia. Therefore, we investigated serum ESM-1 levels and the relationship between inflammation and stress hyperglycemia levels in stress hyperglycemia patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 275 participants included patients who were prospectively recruited between January and May 2015. Grouped the patients by the type of acute myocardial infarction(AMI)(including stress hyperglycemia in patients with STEMI, STEMI patients with type 2 diabetes mellitus(T2DM), STEMI patients with normal glucose levels and non-ST-segment elevation myocardial infarction(NSTEMI)), newly diagnosed untreated T2 DM and control group. Compared the ESM-1 level, high sensitivity C-Reactive Protein(Hs-CRP), neutrophil to lymphocyte ratio(NLR) of each group. General clinical data of subjects in each group were collected, and biochemical parameters including fasting plasma glucose(FPG), hemoglobin A1c(Hb A1c), total plasma cholesterol(TC), triglycerides(TG), high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C), 2 hour postprandial blood glucose(2h PG), Creatinine(Cr), hs-CRP were measured. In patients with AMI,brain natriuretic peptide(BNP), troponin, stress hyperglycemia level and Killip classification were collected. Calculated neutrophil to lymphocyte ratio(NLR),thrombolysis in myocardial infarction(TIMI) Risk Score and Gensini score. The clinical Global Registry of Acute Coronary Events(GRACE) risk score were assessed in each patients with NSTEMI. The patients were followed-up for 3 months and major adverse cardiac events(MACE) were recorded. Logistic regression analysis was used to analyze the risk factor MACE.Results1. Compared to the control group, serum ESM-1 levels were significant higher in AMI group, STEMI group and newly diagnosed untreated T2 DM group[(1.19±0.45)ng/m L vs(1.03±0.03)ng/m L,(1.14±0.28)ng/m L vs(1.03±0.03)ng/m L,(1.09±0.16)ng/m L vs(1.03±0.03)ng/m L,respectively and all P<0.05].2. Serum ESM-1 level was significantly higher in STEMI patients with T2 DM than STEMI patients with normal glucose levels [(1.25±0.50)ng/m L vs(1.06±0.09)ng/m L,P<0.05].There was also significant difference in serum ESM-1 level between the stress hyperglycemia patients with STEMI and STEMI patients with normal glucose levels[(1.14±0.17)ng/m L vs(1.06±0.09)ng/m L,P<0.05]. But there was no significant difference between STEMI patients with T2 DM and stress hyperglycemia patients with STEMI [(1.25±0.50)ng/m L vs(1.14±0.17)ng/m L,P>0.05].3. In stress hyperglycemia patients with STEMI, serum ESM-1 levels correlated positively with glucose levels(r=0.210,P<0.05).4. Single factor Logistic regression analysis indicated that ESM-1>1.01ng/m L [odds ration(OR) 3.011, 95% confidence interval(CI) 1.049~8.642, P=0.04] 、 NLR(OR1.095, 95% CI 1.021~1.175, P=0.01) 、 age(OR1.044, 95% CI1.008~1.082,P=0.02) 、 TIMI risk score(OR1.408, 95% CI1.164~1.704, P=0.00) were the independent predictors of MACE. Multiple factors Logistic regression analysis indicated that ESM-1 level>1.01ng/m L(OR3.543, 95% CI 1.079~11.632,P=0.04) 、 NLR(OR1.113,95% CI 1.026~1.207, P=0.01) were the independent predictors of MACE.Conclusion1. We first report that serum ESM-1 over-expressed in patients with AMI and STEMI,especially in stress hyperglycemia patients with STEMI and STEMI patients with T2 DM, which demonstrated that stress hyperglycemia and T2 DM were the risk factor of endothelial function damage. Our pilot study suggests that ESM-1 is a novel biomarker of endothelial dysfunction, which may be involved in the pathogenesis of STEMI.2. Admission glucose levels are associated with ESM-1 levels in stress hyperglycemia patients with STEMI, which indicated that stress hyperglycemia in patients with STEMI accompanied by significantly endothelial function damage.3. ESM-1 is an independent predictor of MACE. An ESM-1 level>1.01ng/m L is likely to predict a greater risk of MACE in stress hyperglycemia patients with STEMI. |
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