Investigation Of Gender And Inflammatory Response Of Acute Myocardial Infarction Patients And Mechanisms Of Myocardial Damage

Objective:There are gender differences in the recovery of cardiac function in patients with acute myocardial infarction after coronary artery reperfusion.The purpose of this study is to analyze the correlation between the peripheral blood inflammation indicators and myocardial injury indicators in male（M）and female（F）patients with acute myocardial infarction 1 day before percutaneous coronary reperfusion intervention（PCI）and myocardial function 5-7 days after PCI.The expression of nitric oxide synthase（i NOS,e NOS,n NOS）in cardiomyocytes of estrogen and androgen with inflammatory factor IL-6 was detected to determine the mechanism of sex hormones on cardiomyocytes under the action of inflammatory factors.Method:1.603 patients who suffered from AMI for the first time from 2016 to 2019 were recruited,and clinical indicators（WBC,NEU,LYM,MON,NEU/LYM,MON/LYM,CK and CK-MB）one day before the intervention and cardiac functional indexes（LV-EF and LV-FS）5-7 days postoperatively were analyzed.t-test was used to analyze the difference between M and F groups.2.Analyze the correlation between inflammatory cells and myocardial injury（CK and CK-MB）and cardiac function（LVEF and FS）using non-parametric tests,scatter plots,and histograms.M and F are compared between the two groups.3.Stable rat cardiomyocyte cell line（H9C2）were treated with E₂（estrogen）,T（androgen）,IL-6（interleukin-6）,E₂+IL-6 and T+IL-6,respectively.i NOS,e NOS,and n NOS protein expression was detected using western blotting,and the effects of inflammatory factors on the protein expressions with estrogen and androgens were examined.Result:1.WBC,NEU,MON,MLR in M AMI patients are significantly higher than those in F（P<0.05）;CK and FS were also significantly higher in M compared to those in F（P<0.05;P<0.05）.2.Overall data analysis,WBC,NEU,MON,MLR were positively correlated with CK and CK-MB（P<0.05）;NLR was positively correlated with CK（P=0.017）.3.In F group,WBC and LYM were positively correlated with CK and CK-MB（P<0.001）;while in M,WBC,NEU and MLR were positively correlated with CK and CK-MB（P<0.001）.These data indicate that LYM was correlated with myocardial injury indexes and NEU,MON,NLR,and MLR were correlated with myocardial injury index in M group.4.Cardiac functional indexes:WBC,NLR were negatively correlated with FS in F group（P<0.05）.Group M has no correlation,suggesting gender differences.5.In western blotting experiment,IL-6 increased the protein expression of i NOS（P<0.05）.E₂and T treatment reduced the expression of i NOS of IL-6（P=0.04,P=0.01）,but it is still higher than that of normal group（P=0.049,P=0.012）.The expression of i NOS protein in IL-6+E₂and IL-6+T groups was higher than that in the control group（P=0.031,P=0.004）.The expression of i NOS with IL-6+T group was lower than that in IL-6（P=0.030）.IL-6+E₂tended to reduce i NOS（P=0.06）6.IL-6 significantly reduced the protein expression of e NOS（P=0.009）.After E₂treatment,the expression of e NOS was lower than that of the control group,while T did not affect the expression of e NOS.Compared with the control group and IL-6group,the expression of e NOS protein in IL-6+E₂and IL-6+T groups had no effect.7.Expression of nNOS protein:The expression of n NOS protein in IL-6 group was higher than that in control group（P=0.037）.The E₂and T groups had no effect on the expression of n NOS protein（P=0.091,P=0.117）.The expression of n NOS protein in IL-6+E₂group was increased compared with the control group（P=0.035）.The IL-6+T group had no effect on the expression of n NOS protein（P=0.096）.Conclusion:1.The preoperative inflammation of AMI patients is linked with myocardial damage and affects cardiac functional recovery.2.WBC and LYM in female AMI patients are correlated with myocardial injury,while NLR predicts cardiac insufficiency.Most of the inflammatory indicators in male AMI patients are related to myocardial injury,and there is no specific indicator to predict changes in cardiac function.3.After inflammation,sex hormones reduce i NOS in the presence of IL-6.Estrogen promotes the increase of n NOS in myocardial cells,suggesting that it plays a role in myocardial protection.