The Level Changes And Clinical Significance Of Serum C-reactive Protein, Interleukin-10 And Transforming Growth Factor-β₁ In Patients With Acute Coronary Syndrome

Objective: Acute coronary syndrome (ACS) includes unstable angina pectoris, acute myocardial infarction and sudden cardiac death. Its mechanisms are plaque rupture, vasoconstriction and thrombosis on the basis of atherosclerosis. In recent years the pathogenesis of ACS has been found to be closely related to the biological feature of plaques, those with a rich lipid and thin fibrous cap are more vulnerable and prone to rupture. Furthermore, inflammation has been recognized to play an important role in the atherosclerosis from initiation to development. Many studies had shown that there were a lot of inflammatory cells infiltration such as macrophages and T lymphocates around the plaque, and the cytokines expression was increased in the plaque. These findings have led us to regard the atherosclerosis as a chronic inflammatory process. A lot of inflammatory cytokines were studied including interleukin-6 (IL-6), tumour necrosis factor-α(TNF-α), interferon-γ(INF-γ) and so on. However, we know seldom about the role of anti-inflammatory cytokine in atherosclerosis. Both interleukin-10 (IL-10) and transforming growth factor-β(TGF-β) are the members of anti-inflammatory cytokine and play many important roles. We measured IL-10, TGF-β1 and C-reactive protein concentrations in patients with ACS for understanding their effect in process of ACS.Method: 60 patients with coronary artery disease (CAD) were enrolled in the study. They were divided into three groups according to diagnostic criteria for CAD of 1979 WHO as well as their coronary angiographical results. SAP group consisted of 20 patients with stable angina pectoris (SAP). ACS group consisted of both 20 patients with unstable angina pectoris (UAP) and 20 with acute myocardial infarction (AMI). The control group consisted of 20 subjects without CAD. Subjects would be excluded if they had any active infections, autoimmune disease, hepatic or renal dysfunction, cancer, LVEF <50%, recent surgical operations and cerebral or peripheral vascular disease.Blood samples were obtained from venous at the next morning after admission of the patients of SAP, UAP and control groups. The blood samples of patients of AMI group were obtained immediately after admission. Serum was obtained by centrifuging method at 3000 r/min for 10 minutes. CRP concentration was measured by nephelometry while IL-10 and TGF-β1 by ELISA. All statistical analysis was performed with SPSS 11.0. Data were expressed as means ± standard deviation value(X±S), and statistical significance was considered if p≤0.05.Result1 There is no significant difference in age and sex in all 3 groups. The number of subject with a smoking history, hypertension, diabetes mellitus and hyperlipemia does not show significantly difference among the three groups.2 Serum level of CRP in ACS group is significantly higher than SAP group ( 2.73±1.71 v 1.35±1.60 , p<0.01) and control group ( 2.73±1.71 v 1.24±1.39, p<0.01 ). IL-10 level in ACS group is significantly lower than SAP group ( 10.41±1.50 v 12.38±0.77, p<0.01) and control group ( 10.41±1.50 v 12.48±0.94, p<0.01). TGF-β1 level in ACS group is significantly lower than control group ( 13.13±7.77 v 19.51±8.71, p<0.01). There is no significantly difference in CRP, IL-10 and TGF-β1 between UAP and AMI group. CRP levels were related inversely with IL-10 levels (r=-0.42, P<0.01).Conclusion: Inflammatory factor CRP is increased and anti-inflammatory cytokine IL-10 and TGF-β1 are decreased in patients with ACS. There is a balance between inflammation and anti- inflammation in healthy body. The balance is broken in atherosclerosis and especially in ACS. Inflammation is intensified while anti-inflammatory effect becomes weak. They are very important for further understanding the mechanism of ACS.