| Objective To investigate the changes of MDA,SOD and GSH redox state in plasma of patients with acute ST-segment elevation myocardial infarction before and after acute coronary intervention to explore the changes of oxidative stress in STEMI patients under different groups,and to discuss the changes,relationships and prognosis of GSH redox state in patients with acute myocardial infarction.Method 1.Selected from January 2015 to August 2016 in The First Affiliated Hospital of Chengdu Medical College of cardiovascular medicine for the first time within 12 hours of treatment and to accept percutaneous coronary intervention and the successful opening of the blood vessels of the acute ST segment elevation myocardial infarction patients,a total of 93 cases.Primary PCI was performed using conventional techniques.We excluded patients with symptom onset>12 hours,underlying cancer,chronic inflammatory disease,or any systemic infection that occurred during the first 24 hours after admission.Patients were treated with reference to the Chinese Medical Association Cardiovascular Society and other developed "diagnosis and treatment of acute myocardial infarction guidelines",the main measures include percutaneous coronary stent implantation and postoperative anticoagulation,antiplatelet treatment,correction of arrhythmia,heart failure and symptomatic supportive care.2.Preoperative and postoperative 24 h were taken from patients with elbow vein blood 5ml.MDA content,SOD activity,GSH and GSSG content in plasma were measured by enzyme-linked immunosorbent assay(ELISA).Then the GSH/GSSG ratio and the redox potential of GSH/GSSG redox couple(i.e.Eh(GSH/GSSG))were calculated.3.According to the different myocardial infarction sites,the anterior wall group and the non-anterior wall group.According to the number of vascular stenosis divided into single lesion group,double-vessel disease group and three-vessel disease group.The differences of plasma oxidative stress and GSH redox state between the two groups were compared.4.That 93 patients were followed up for 180 consecutive days,and they were divided into no adverse event group 72 cases,21 cases of adverse events group according to whether the occurrence of MACE.The differences of plasma GSH redox state between the two groups were compared.5.To evaluate the diagnostic value of Eh(GSH/GSSG)in the prognosis of patients with myocardial infarction.To explore and find the independent risk factors for MACE events after PCI in patients with myocardial infarction.Results 1.Compared with preoperative PCI,plasma MDA levels increased after PCI(p<0.05),the levels of GSH and GSH/GSSG were decreased(p<0.05),the levels of GSSG were not significantly change(p<0.05),and the levels of Eh(GSH/GSSG)were increased(p<0.05).2.There was no significant difference in the levels of MDA and SOD between the two groups(p>0.05).There was no significant difference in GSSG and GSH/GSSG levels between the two groups(p>0.05)and Eh(GSH/GSSG)were higher(p<0.05).There was no significant difference in plasma MDA and SOD between the two groups(p>0.05),GSH and GSH/GSSG levels were lower(p<0.05),and there was no significant difference between the two groups(p>0.05),Eh(GSH/GSSG)was still at a higher level(p<0.05).There were no significant differences in plasma GSH,GSSG,GSH/GSSG and Eh(GSH/GSSG)levels between pre-PCI,single-vessel disease,double-vessel disease and three-vessel disease group(p>0.05),but there was no significant difference in the levels of GSH,GSSG and GSH/GSSG(p>0.05),and no significant difference(p<0.05)between any two groups(p>0.05),and the number of patients with coronary heart disease increased,Eh(GSH/GSSG)levels were correspondingly increased.3.Compared with the non-MACE group,the levels of MDA,SOD,GSH,GSSG,GSH/GSSG and Eh(GSH/GSSG)in the MACE group were not significantly different(p>0.05).There was no significant difference in GSSG level between MACE group and MACE group(p>0.05).The level of GSH,GSH/GSSG was lower(p<0.05),and the level of Eh(GSH/GSSG)was higher(p<0.05).The optimal threshold for predicting the MACE event Eh(GSH/GSSG)is-122.5 m V,with a sensitivity of 71% and a specificity of 76%.In the Kaplan-Meier survival analysis,the incidence of MACE was significantly different between the high-risk group and the low-risk group(p<0.05),and the incidence of MACE was significantly different within 30 days(p<0.05)Significant difference(p>0.05).Multivariate Cox proportional hazards analysis,24 hours Eh(GSH/GSSG)≧-122.5m V(HR 4.25,p=0.005,95% Cl 1.56-11.55),chronic kidney disease(HR 3.70,p=0.008,95% CI 1.40-9.76),left ventricular ejection fraction(5% HR 0.94,p=0.005,95% CI 0.90-0.98).Conclusion 1.The activity of SOD,the content of MDA and the level of Eh(GSH/GSSG)in peripheral blood of patients with STEMI were significantly higher than those of patients with STEMI.The results showed that myocardial ischemia and reperfusion injury caused free radical burst,GSH,GSH redox state to oxidative direction shift,oxidative stress aggravated.2.The level of plasma GSH was lower and the level of Eh(GSH/GSSG)was higher in patients with STEMI than in the anterior wall of patients before and after PCI.Indicating that the infarct site in the anterior wall will cause more severe oxidative stress and ischemia-reperfusion injury.There was no significant difference in the redox status of GSH in patients with different number of coronary arteries before PCI.The number of coronary arteries was increased and the level of Eh(GSH/GSSG)increased at 24 h after PCI.Indicating that the number of coronary lesions and ischemic reperfusion after the level of oxidative stress was positively correlated.3.Peripheral plasma Eh(GSH/GSSG)levels can be used to stratify the risk stratification of patients treated with PCI in STEMI.The risk of MACE was increased in STEMI patients with plasma Eh(GSH/GSSG)≧-122.5m V after PCI.Eh(GSH/GSSG)had an independent predictive value for MACE after PCI in STEMI patients. |
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