Influence Of Admission Glucose Concentration On The Levels Of CRP,MCP-1 Preoperative And Postoperative In Patients With Acute Myocardial Infarction Treated By Primary Percutaneous Coronary Intervention

Acute myocardial infarction (AMI) is that the myocardium of which blood supply suddenly reduced or interrupted based on the coronary artery lesion have been ischemic and necrosis. In acute stage, the mortality of the patients with AMI who didn't treated by reperfusion strategies is12% to 14%, which higher than that who did. Consequently, The reperfusion strategies which can recover the blood supply is especially important. The primary percutaneous coronary intervention (PCI) are the main and effective reperfusion strategy, which can recover the blood supply of the infarcted myocardium quickly and effectively, degrade the mortality of the patients with AMI, improve prognosis of these patients. Although treated by reperfusion strategy, patients with AMI for diabetic have inferior clinical prognosis than for non-diabetic. Moreover, for non-diabetic, the elevated plasma glucose at admission also be one of reasons for the unfavourable prognosis of patients with AMI. Inflammatory factor is that produced and secreted by inflammatory cell participated in Inflammatory reaction. The levels of C-reactive protein (CRP)and monocyte chemoattractant protein (MCP-1) can reflect the degree of the inflammatory reaction, are a prognosis index for coronary heart disease, especially for those patients treated by PCI, are correlated with restenosis (RS) after PCI. Knowledge of levels of CRPand MCP-1 may improve initial risk stratification. Previous studies suggest that hyperglycaemia in patients with AMI may enhance inflammatory reaction,influnce the outcome of patients with AMI. Previous studies investigating the effect of admission glucose levels on levels of the inflammatory factor (especially CRPand MCP-1) preoperative and postoperative in patients with AMI treated by primary PCI are rare reported.Objectives: To observe the effect of admission glucose levels on levels of CRPand MCP-1preoperative and postoperative and short-term outcome in patients with AMI treated by primary PCI, to discuss the possible mechanisms of those effect.Methods: 1. Groups: A total of 73 patients with AMI treated with successful primary PCI within 12 hours after onset of symptoms, admitted in cardiovascular medical department and intensive care unit (ICU), the first hospital of Jilin university, between November 2005 and January 2007, with complete data, were classification according to plasma glucose levels at admission and with diabetes or nodiabetes: groupⅠ, nondiabetic with blood glucose level<8.0mmol/L; groupⅡ, nondiabetic with blood glucose level≥8.0mmol/L; groupⅢ, diabetic. 2. Sample collection: All patients were drawed blood for 3 ml from ulnar vein preoperative and 24 hour, 48 hour postoperative and put into test tube (no decoagulant). Those samples were centrifuged 10 minutes by 3000r/min immediately. Then we take upper stratum blood serum and put it in test tube. Collected samples were preserved in icebox with -20℃waiting for measured together. 3. Measure of blood serum CRP,MCP-1: Using the method of enzyme-linked immunosorbent assay (ELISA) measure levels of blood serum CRP,MCP-1preoperative and 24 hour, 48hour postoperative. 4. Statistics analysis: Measurement data are expressed as means±SD ( x±S). Analysis of measurement data use analysis of variance (ANOVA) or rank-sum test. Analysis of numeration data useχ2test, all statistical analysis were done using SPSS11. 5. Pvalue<0.05 was considered statistically significant.Results: 1. The general clinical setting: There were no difference among three groups in general state of health, exemple for age, sex, blood fat, creatine kinase, smoking history, hypertensive history, cerebrovascular disease history, however, the plasma glucose levels of group III were higher than other groups; There weren't difference in the incidence rates of serious cardiac arrhythmia in operation and heart failure duration of hospital stay group comparison, but the incidence rates in group III and group II were higher than that in group I.2. The interventional data: The constituent ratio of multivessel disease in group 3 was higher than other groups (P<0.05). 3. The level of CRP (mg/L): There were significantly difference among groups in levels of CRP, not only preoperative but also postoperative. the CRP levels of group III were higher than other two groups (P< 0.05), and that of group II higher than group I (P<0.05); Compared with preoperative, the level of CRP 24 hour postoperative has been heighten most in group III (66.2%VS group I 49.6%, group II 58.4%), and the level in group III 48 hour postoperative haven't obviously decrease tendency, however the CRP level of group I 48 hour postoperative decreased obviously compared with 24 hour postoperative (P<0.05). 4. The level of MCP-1 (pg/ml): The level of MCP-1 postoperative was higher than preoperative (P<0.05). Compared with group II and III, the extent of MCP-1 highten in group I were small (group I 49.14%, groupII 65.1%, group III, 78.3%), and the level of group I decreased early, the level 48 hour postoperative decreased obviously compared with that 24 hour postoperative (P<0.05). However, there weren't obviously difference between 48 hour and 24 hour postoperative in group II and III (P>0.05). Compared with group I, the levels of MCP-1 preoperative and postoperative in group 2 and group 3 were significantly higher, and that in group 3 were higher than group 2 (P<0.05).Conclusions:1.Patients with AMI often accompany with elevated blood glucose level at admission, with diabetic or not. The blood glucose level in diabetic were higher than that in nondiabetic. The stress reaction is the main mechanism of elevated blood glucose in patients with AMI. 2. Patients with both coronary heart disease (CHD) and diabetes have serious coronary artery lesion, more multivessel disease. 3. Hyperglycaemia in patients with AMI at admission increase the incidence rates of serious cardiac arrhythmia in operation and heart failure duration of hospital stay. 4. The levels of CRP and MCP-1 after primary PCI in patients with AMI were higher than that preoperative, which may be concerned with Inflammatory reaction intensified by PCI. 5. Hyperglycaemia in patients with AMI at admission increase levels of CRP and MCP-1 in blood, that effect is more obviously after PCI.Levels of CRP and MCP-1 are correlated with restenosis (RS) after PCI, Inflammatory reaction intensified by hyperglycaemia may be one of mechanisms which hyperglycaemia influence outcome of patients with AMI treated with PCI. Therefore, we shoud pay more attention to hyperglycaemia. Knowledge of admission glucose levels may improve initial bedside risk stratification. Some treatments shoud be done to AMI patients with hyperglycaemia (for example insulin treatment), to decrease elevated blood glucose levels, may conduce to improve the outcome of these patients.