The Relationship Of Lp-PLA₂ And SCD40L Levels In The Plasma With Myocardial Ischenia Referfusion Injury In Patients With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Objective:With the continuous development of coronary intervention,myocardial ischemia reperfusion injury（MIRI）has become one of the inevitable problem in clinical diagnosis and treatment.Nowdays,The specific mechanism of MIRI is still unclear.inflammation may be one of potential mechanisms in the occurrence of myocardial ischemia reperfusion injury.Lipoprtein-associated phospholipase A₂ is a vascular-specific biomarker.It not only participates in the occurrence of inflammatory reactions in the body,but also plays an important role in the development of myocardial reperfusion injury.Soluble CD40 ligand（sCD40L）is an activated form of CD40 L in vivo and is an important proinflammatory mediator.sCD40L is not only a prefictor of coronary heart disease,but also an evaluation factor for malreperfuion.However,the relationship between the levels of Lp-PLA₂ and sCD40 L and myocardial ischemia-reperfusion injury has not been reported.This study was to investigate the correlation between the levels of Lp-PLA₂ and sCD40L in plasma and myocardial ischemia reperfusion injury in patien-ts with acute myocardial infarction undergoing primary percutaneous coronary intervention（PPCI）,which is to Learn more about the role of inflammatory responses in myocardial ischemia-reperfusion injury.Methods:Continuously selected 80 patients in our hospital from September2017 to June 2018 for the first time to diagnose acute myocardial infarction and underwent emergency PCI in 12 hours.67 patients who had no obvious abnormalities in concurrent coronary angiography due to chest discomfort at the same time were selected as the control group.According to the diagnostic criteria of ST-segment elevation myocardial infarction,the patients were selected,and the basic data of the patients and the myocardial ischemia-reperfusion injury events were collected.The levels of sCD40L and Lp-PLA₂ in plasma samples collected from patients before and after treatment were determined by ELISA.The plasma levels of sCD40L and Lp-PLA₂ in patients with acute myocardial infarction treated with emergency PCI were compared with those in the control group,and the changes of concentration level in ischemia reperfusion injury.Multivariate logistic regression was used to analyze the correlation between Lp-PLA₂ and sCD40L and myocardial ischemia reperfusion injury events.Evaluation of the predictive power of Lp-PLA₂ and sCD40L levels for myocardial ischemia-reperfusion injury using receiver operatin-g curve（ROC curve）Results:A total of 147 patients were enrolled in the study,including 80 in the AMI group and 67 in the control group.The levels of Lp-PLA₂ and sCD40L in the AMI group before and after PCI were higher than those in the control group（P<0.05）,and the levels of Lp-PLA₂ and sCD40L after PCI were Significantly higher than before PCI（P<0.05）,while There was no significant change in the levels of Lp-PLA₂ and sCD40L before and after the control group.MIRI occurred in 29 patients in the AMI group,and the levels of Lp-PLA₂,sCD40L and difference before and after PCI treament were significantly higher in the myocardial ischemia reperfusion injury group than in the non-reperfusion injury group.Multivariate logistic regression analysis showed that the levels of Lp-PLA₂ and sCD40L in the post-PCI treatment and difference before and after PCI treament were the risk factors for MIRI.The area under the ROC curve was 0.867,0.749,0.834,and 0.685,respectively（P<0.05）.ConclusionSoluble CD40 ligand（sCD40L）and lipoprotein-associated phospholipase A₂（Lp-PLA₂）may be involved in the development of myocardial infarction,and have a good correlation with the occurrence of myocardial ischemia reperfusion injury,which has a good predictive value for the development of myocardial ischemia-reperfusion injury.