Changes Of Plasma SCD40L And PAPP-A In Patients With Acute Myocardial Infarction

Objective:To investigate the changes and significance of plasma pregnancy-associated plasma protein-A (PAPP-A) and soluble cluster of differentiation 40 ligand ( sCD40L) in acute myocardial infarction (AMI) patients pre and after emergency Percutaneous Coronary Intervention (PCI) operation in two weeks. Methords:Plasma level of PAPP-A and sCD40L in 50 AMI patients were assaied within onset 6～12h of AMI(before PCI) and at 1d, 2d, 3d, 5d, 7d and 14d by Enzyme-linked immunosorbent assay (ELISA). Meanwhile, the plasma level of the two inflammatory factors in 25 controls also were detected at pre-operation coronary artery angiography .The AMI group was divided into 3 sub-groups: the death group (the severe complication group), the complication group(Angina Pectoris,stent thrombosis,Heart failure etc ) and the no complication group.Results:l. Plasma level of PAPP-A and sCD40L of the controls at pre-operative were lower in patients than those of AMI, respectively PAPP-A10.69±2.48 pg/ml vs27.84±6.37 pg/ml, sCD40L 343.24±26.35ng/L vs555.40±63.63 ng/L (each P<0.01);2. The plasma concentration of PAPP-A and sCD40L was positively correlated with Gensini score, the more obvious the concentration of PAPP-A and sCD40L was increased, the higher Gensini score.3. In the three sub-groups, plasma concentrations of PAPP-A at post-operative 24h were observably higher than at pre-operative. The complication group and the no complication group had already decreased on 48h, but the serious complication group which was not increased until at post-operative on 5 day began to decrease on 7 day. On post-operative two weeks , the complication group and no complication group had alreadyly lowed to pre-operative level, but the serious complication group was still higher than pre-operation level.The differenet time points and the interaction of among groups and the different time points, the each differences were statistically significance among three groups,. 4. Plasma levels of sCD40L had already also began to increase after one day in the three sub-groups, the peak value concentrations of the no complication group and the death group had been reached by post-operation 48h, then decreased gradually, but the more serious in condtions, the slower in decline. The different time points, the interaction of among groups and the different time points among three groups, the differences were statistically significance.5. In patients with the complication group and no complication group the concentration's comparision of PAPP-A and sCD40L. The concentration of PAPP-A reached to the peak value after 24h post-operation in complication group, followed by slow decline, were still significantly higher than the no complication group on 14d, the difference was statistically significance (P<0.05). In no complication group, the concentration of PAPP-A also reached to its peak value at 24h post-operation in no complication group. But in complication group, its concentration rapidly declined and had alreadily decreased to normal on 5d. The concentration of sCD40L reached its peak value in the 48h and subsequently decreased slowly, were still significantly higher on two weeks, but the concentraion of the no complication group decreased to normal on one week.Conclusions: 1. If their peak did not fall or continued to delay, it implied that the condition was very serious, the plasma concentrations of PAPP-A and sCD40L significantly increased in patients with AMI. The determination of PAPP-A and sCD40L in patients with AMI could have obvious predictive value for recent therapy and prognosis after emergency PCI.2.The plasmic levels of PAPP-A and sCD40L were observative dynamicly in patients with AMI after emergency PCI, Which would be used as a predictive marker for assessing the clinical conditions and the development of cardiovascular events, and can obviously promote coronary artery local lesion occurrence and development. It is very important clinical significance for guiding clinical early positive intervention and timely preventing complications to take place.