| Objective:Acute myocardial infarction (AMI) is a serious type of coronary heart disease, it reflects the acute onset, many complications and moreover a higher fatality rate, Currently it is one type of diseases which threaten human's life. Strictly speaking, AMI is the result that coronary atherosclerosis involvement in multi-cell and factors strong inflammatory reaction. Compared with the merely AMI, AMI accompanied by different risks of complications in patients takes a higher incidence of fatal events. Therefore, exploring the changes of inflammatory factors in acute phase may be an early prediction and early treatment, which can prevent or delay the occurrence and development of coronary artery disease in patients with AMI. There is a number of clinical indicators which can be used to evaluate the severity of AMI, such as ECG, UCG, enzymes, the initial blood glucose, blood lipids, Hs-CRP, etc, but it is necessary to explore more sensitive and convenient indicators in our clinical work. The study have showed that various complications of coronary heart disease have different levels of adiponectin (APN).APN was discovered in 1995, which come from the fat cells. It is closely related to obesity, diabetes, and insulin resistance. Recent researches found that the relationship between APN and coronary heart disease is also quite important. Studies have shown that APN has not only the role of anti-AS, but also related to atherosclerotic plaque rupture. In this experiment, the adiponectin levels in patients with AMI was studied ,so as to discuss the serum adiponectin levels and clinical significance of drug intervention in patients of pure AMI and AMI with different complications.Method:131 patients with AMI during hospitalization from May 2009 to Oct 2009 in CCU of the Second Hospital of Tianjin Medical University were enrolled and divided into different groups according to their complications. The merely AMI group is group A, AMI with hypertension group is group B, AMI with diabetes group is group C, AMI with hypertension and diabetes group is group D. Detecting the Serum adiponectin level of each group respectively and conducting statistics analysis. Choosing the merely AMI group (41 cases) as the drug group, Patients were randomly divided into two groups, CDDP group and the control group, detecting the Serum APN level 1 month again..Serum APN levels is detected by Enzyme-linked immunosorbent assay (ELISA), all subjects admitted to hospital must take blood immediately, measure blood glucose, insulin, uric acid, cholesterol, HbAlc, triglyceride, C-reactive protein, blood pressure, body mass index (BMI) and other relevant information.Results:1. Patients of AMI with hypertension group with diabetes group,with both hypertension and diabetes group whose total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) level was higher than that of the merely AMI group (P<0.05), APN was negatively correlated with TC,LDL-C; their high-density lipoprotein cholesterol (HDL-C) level was less than the merely AMI group (P<0.05). APN was positively correlated with HDL-C.2. Serum Hs-CRP levels of AMI with hypertension group or diabetes group or hypertension and diabetes groups were higher than that in patients with the merely AMI group (P<0.05). AMI with both hypertension and diabetes, serum Hs-CRP levels were higher than those with hypertension or diabetes and the merely AMI (P<0.05). APN was negatively correlated with Hs-CRP.3. APN in the AMI group with hypertension and diabetes is the lowest ,but with diabetes or hypertension was no significant difference, the merely AMI is higher than the AMI group with hypertension and diabetes.4. The merely AMI group which intervented with drug(CDDP) 1 month later, Compared with non-treatment group, APN increased significantly, the difference was significant. The changes of the intervention group before and after treatment in APN level were significantly different.Conclusions:1. For AMI, the more complications, the more serious glucose and lipid metabolic disorders, the worse prognosis. Compared to those with merely AMI, APN levels in AMI with different cmplications groups was lower significantly, particularly AMI with hypertension and diabetes mellitus group, it suggested that APN is related to the development of coronary atherosclerosis disease and plaque instability. hypertension, diabetes mellitus involved in the APN consumption.2. Inflammatory factors(Hs-CRP) and serum APN in AMI with different complications was significantly negatively correlated. The results further showed that APN protected artery from injuring,it maybe take part in antagonizing the injury of artery wall by inflammatory factors. it also has some value to predict the occurrence of acute coronary events.3. The APN level in CDDP group was higher than in the untreated group significantly, it is predicted that CDDP may protect vascular endothelium, increase APN level and reduce coronary artery inflammation,it may inhibit the progress of coronary artery disease.4. APN as an inhibitor of inflammation,its expression was significantly decreased in coronary heart disease, especially in AMI. Patients with complications associated with lower expression which can directly affect the development and rupture of atherosclerotic plaque. The degree of APN's decline and how much complications the AMI patients have was positively correlated. |
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