Relationship Between Serum Level Of Tumor Necrosis Factor-alpha, Matrix Metalloproteinase-9 And Interleukin-6 And Clinical Prognosis And The Effects Of Compound Danshen Dripping Pill On STEMI

Objective:As a serious kind of coronary heart disease, acute myocardial infarction (AMI) has attracted more and more attention for its serious condition changes and a state of high mortality and mutilation rate. So, how to improve clinical prognosis has become a focus topic. It is confirmed that complications of post-AMI can directly affect the prognosis. Previous study proved inflammation involves in AMI. Further studies need to be carried out to assess whether inflammation is associated with disturbed electrocardial action and left ventricular remodeling, and whether anti-inflammation may improve the prognosis by attenuating unstable activity of atheromatous plaque. "Compound danshen dripping pill (CDDP)" is a Chinese drugs preparation which has many cardiovascular protective effects. The aim of this study is the following:1) identify predictive inflammation factors of AMI patients in developing major adverse cardiac events (MACE) and 2) evaluate the effect of CDDP treatment on inflammatory makers, tumor necrosis factor-alpha (TNF-a), matrix metalloproteinase-9 (MMP-9) and interleukin-6 (IL-6).Methods:From March to December 2009,163 patients with ST segment elevation acute myocardial infarction (STEMI) were enrolled within 24 hours after chest pain onset while admission. Venous blood samples were obtained immediately to detect TNF-a, MMP-9 and IL-6. All patients were randomly divided into two groups:Control group (n=85) with conventional therapy and CDDP group (n=78), with CDDP 10 pills three times a day additional until one month after discharge. All patients were followed up. MMP-9 and IL-6 were detected once more in 97 of them at 30 days and MACE was recorded during hospitalization and follow-up. Observe the incidence rate of primary adverse cardiac events (including cardiac death and all-cause death) and lesser adverse cardiac events (including acute heart failure, malignant arrhythmia, cardiogenic shock, readmission for angina pectoris or heart dysfunction, non-fatal myocardial infarction and stroke) between two groups and evaluate the relationship of inflammatory makers and adverse cardiac events. The statistical software SPSS 11.5 was employed to perform data analysis. Results:No significant difference of admission TNF-a, MMP-9 and IL-6 levels were found between CDDP group and control group (p>0.05). Post-treatment concentrations of MMP-9 and IL-6 were significantly decreased in both CDDP group and control group (p<0.01). Compared with control group, the variance in CDDP group was much significant (p<0.05). The incidence rate of lesser adverse cardiac events was significantly different between 25.6% for CDDP group and 44.7% for control group (p<0.05). While no significant difference of the primary adverse cardiac events in incidence rate was found between CDDP group (6.4%) and control group (12.9%) (p>0.05). MMP-9 and IL-6 levels of MACE on admission and TNF-a level of lesser adverse cardiac events were much higher in sudden cardiac attack group than those in sudden cardiac attack-free group (p<0.05). Admitted concentrations of TNF-a, MMP-9 and IL-6 were closely related to the MACE attack which was detected by logistic regression analysis.Conclusion:CDDP can decrease serum level of MMP-9 and IL-6 in patients with STEMI and have beneficial effects on anti-inflammation and stabilizing the plaque. Concentration of TNF-a, MMP-9 and IL-6 in serum is related positively to incidence of sudden cardiac attacks. Elevated TNF-a, MMP-9 and IL-6 levels on admission maybe affect the prognosis of STEMI patients.