| Objective:1.The endogenous thiol compounds glutathione(GSH),homocysteine(Hcy)and cysteine(Cys)in the serum of patients with acute myocardial infarction(AMI)are separated by chirality to obtain the enantiomers DL-GSH,DL-Hcy and DL-Cys.To explore the correlation between the enantiomers of these three thiol compounds and the risk factors of AMI,and screen out new biomarker for the diagnosis of AMI,so as to provide new reference indexes for the diagnosis of AMI.2.By dynamically monitoring the concentration changes of DL-GSH,DL-Hcy and DL-Cys in the serum of patients with AMI with the extension of treatment cycle,to explore the feasibility of evaluating the treatment effect of patients with AMI by the enantiomers of endogenous thiol compounds.Methods:1.From December 2020 to January 2021,30 AMI inpatients(25 cases of ST-segment elevation patients and 5 cases of non-ST-segment elevation patients)were selected from the chest pain clinic of the Affiliated Hospital of Yanbian University.5ml of elbow venous blood was collected immediately after admission(the first day of admission).Twenty patients in the AMI group(including 15 ST-segment elevation patients and 5 non-ST-segment elevation patients)who met the emergency Percutaneous coronary intervention(PCI)treatment conditions were selected.During hospitalization,they were improved and discharged after standardized treatment of AMI such as antiplatelet aggregation,anticoagulation,plaque stabilization and prevention of ventricular remodeling.5ml of elbow vein blood was collected on the morning of the 3rd,5th and 8th day after admission;In addition,During the same period,30 cases without coronary heart disease matched with age and gender of AMI group were randomly selected as the control group from the volunteers who participated in health examination in the Affiliated Hospital of Yanbian University.Similarly,5ml of fasting elbow vein blood was collected,The above blood samples were centrifuged within 2 hours after collection,the serum was retained,labeled and placed in the refrigerator at-80 ℃ for centralized detection.2.Collect the general clinical medical datas: Gender,age,smoking history,combined disease(hypertension,diabetes etc)in AMI group and control group were also analyzed.3.Based on the new mass spectrometry chiral derivatization reagent(R)-(5-(3-isothiocyanopyrrolidone-1-yl)-5-oxopenyl)triphenylphosphorus(NCS-OTPP),the endogenous thiol compounds GSH,Hcy and Cys in serum were identified by UHPLC-HRMS and chiral resolution was carried out.The concentration levels of D-GSH,L-GSH,D-Hcy,L-Hcy,D-Cys and L-Cys were determined(umol/L).4.Use statistical analysis to compare the concentration levels of D-GSH,L-GSH,D-Hcy,L-Hcy,D-Cys and L-Cys between the control group and AMI group at admission(the first day of admission),Binary Logistic regression analysis was used to investigate whether D-GSH,L-GSH,D-Hcy,L-Hcy,D-Cys and L-Cys were risk factors for AMI and identify candidate biological markers,The potential of candidate biomarkers to diagnose AMI was further evaluated by ROC curve;To monitor the change trend of the enantiomer concentration of thiol compounds after chiral resolution in patients with AMI on the 1st,3rd,5th and 8th day after hospital admission(the early stage of treatment,the middle stage of treatment and before discharge).Further judge the relationship between the trend and the therapeutic effect of AMI.Results:1.There were no significant differences between AMI group and control group in gender,age,smoking history,prevalence of hypertension and diabete(P>0.05).2.Comparison of serum enantiomer levels between AMI group and control group on the first day of admission: After chiral separation,L-GSH,D-Hcy,L-Hcy,D-Cys and L-Cys were measured between the AMI group and the control group,but D-GSH was not measured.The concentration of L-GSH in AMI group was significantly lower than that in control group(2.67±0.57umo/l vs 3.18±0.41umo/l,P<0.05);The concentrations of L-Cys(339.88±45.68umo/l vs 290.31±38.12umo/l,P<0.05),D-Hcy(0.10±0.05umo/l vs 0.07±0.02umo/l,P<0.05)and L-Hcy(13.33±4.39umo/l vs8.06±1.71umo/l,P<0.05)in AMI group were significantly higher than those in control group;There was no significant difference in D-Cys concentration between AMI group and control group(0.89±0.22umo/l vs 0.83±0.19umo/l,P>0.05).3.Binary logistic regression analysis: The L-GSH,D-Hcy,L-Hcy and L-Cys with significant differences between groups were analyzed by binary Logistic regression,L-Cys(OR=3.919,95% CI: 1.040-14.765,P < 0.05),D-Hcy(OR= 3.287,95% CI:1.083-9.981,P < 0.05)and L-Hcy(OR= 63.305,95% CI: 5.492-776.5,P < 0.05)were the risk factors for AMI.4.The evaluation of ROC curve analysis on the value of D-Hcy,L-Hcy and L-Cys in the diagnosis of AMI: D-Hcy,L-Hcy and L-Cys as candidate markers for the diagnosis of AMI,The area under the curve of L-Hcy in the diagnosis of AMI was0.9033(95% CI: 0.799-0.964),the cut-off value was 9.15 umol/l,the sensitivity was0.867,and the specificity was 0.833;The area under the curve of D-Hcy in the diagnosis of AMI was 0.6906(95% CI: 0.558-0.804),the cut-off value was 0.065umol/l,the sensitivity was 0.700,and the specificity is 0.567;The area under the curve of L-Cys in the diagnosis of AMI was 0.8100(95% CI: 0.703-0.917),the cut-off value was 348.445 umol/l,the sensitivity was 0.533,and the specificity was 0.933.5.In the AMI group of 20 patients who underwent emergency PCI,the concentrations of thiol compounds enantiomers after chiral resolution were dynamically monitored,and the trend was analyzed by broken line graph.It was found that the concentrations of D-Hcy,D-Cys and L-GSH increased first and then decreased with the improvement of the disease,while the concentration of L-Cys continued to increase.The concentration of L-Hcy showed decreased gradually.Conclusion:1.D-Hcy,L-Hcy and L-Cys are risk factors for the occurrence of AMI,and can predict the occurrence of AMI to a certain extent.2.L-Hcy is characterized by high specificity and sensitivity for the diagnosis of AMI,so L-Hcy is expected to be used as a new biomarker for the diagnosis of AMI.3.The concentration of L-Hcy in patients with AMI shows a gradual downward trend with the improvement of their condition.so it is speculated that dynamic monitoring of serum L-Hcy concentration is helpful to evaluate the therapeutic effect of patients with AMI. |
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