| Objective:The acute coronary syndrome is a set of clinical syndrome caused by acute myocardial ischemia. The current evidence suggests that inflammation is one of the related factor caused the formation and development of atherosclerotic plaque,and it is found that the inflammation plays an important role in occurrence and development of ACS. Visfatin is a kind of adipocytokines.In recent years, many researches show that visfatin was related closely with inflammation, hypoxia, endothelial dysfunction, vulnerable plaques rupture, angiogenesis, glycometabolism, lipid metabolism and so on,and had a hand in the process of atherosclerosis broadly.High-sensitivity-protein C-reactive(Hs-CRP) is a kind of reactive protein in period of acute inflammatory,which considers as a sensitive and reliable inflammatory marker.The level of Hs-CRP can reacte the load of inflammation in atherosclerosis and the severity of coronary heart disease.Research shows that,Visfatin is significantly correlated with Hs-CRP and leukocyte,and it maybe promote unstable plaques'occurrence. Therefore,The further study to visfatin and Hs-CRP will contribute to the awareness of atherosclerosis development and provide a new ideas for prevention and treatment of atherosclerosis. This article research that, the dynamic variation of serum visfatin and Hs-CRP level and its correlation in acute coronary syndrome patients,the correlation of serum visfatin level with the severity of ACS patients and the occurrence of Major Adverse Cardiovascular Events in future,to explore the possibility of visfatin as a biological indicator used to monitor the development of ACS and the value of visfatin used to assess the severity of ACS and infer the prognosis of ACS.Methods:80 patients with thoracodynia diagnosed ACS,who came from the inpatients of 2th hospital affiliated with the HEBEI Medical University(50 males and 30 females), with average age of (55.30±9.18) years,Body Mass Index(BMl)(22.45±1.96)kg/m.30 healthy staffs were recruited as normal control group(18 males and 12 females), with average age of (54.96±7.34) years,BMl(21.19±2.19)kg/m2. According to the history and the examination results,the patients with ACS were divided into three groups:30 patients with ST-elevation myocardial infarction (STEMI)(19males and 11 females), with average age of (55.12±9.23) years,BMl(22.67±1.89)kg/m2; 30 patients with non-ST-elevation myocardial infarction(NSTEMI)(18 males and 12 females), with average age of (53.77±8.45) years,BMl (21.25±2.88) kg/m2; 20 patients with unstable angina (11 males and 9 females),with average age of (53.31±11.06) years,BMI(22.18±1.15)kg/m2.All subjects had excluded that:(1)Merging infectious diseases,such as serious upper respiratory tract infection,lungs and biliary infections,etc.(2)Autoimmune diseases, malignant tumor. (3)Cerebrovascular disease, systemic large-artery disease. (4) Applicating anti-inflammatory drugs,such as steroids antiphlogistic analgesics, steroids and opium drugs,etc.(5)Hepatic and kidney disease and metabolic disease(diabetes, thyroid function hyperthyroidism, hyperlipidemia). (6) operation or wound in the one months.(7)The time of chest pain onset with ACS exceeding 12 hours. (8)Over 80 years of age, BMI≥25kg/m2 and <18.5kg/m2. The age, sex, BMI, blood-lipid and blood pressure showed no difference among three groups. All selected patients were given the ACS standardized treatment, offer conventional acquisition history and laboratory tests. All patients with ACS were taken 4 times ulnar venous blood 5ml on an empty stomach at 12th hour(8-10 hours without food),3th day,7th day and 14th day of chest pain onset.Control group were taken 1 time ulnar venous blood 5ml on an empty stomach. The levels of serum visfatin were determined by enzyme-linked immunosorbent assay (ELISA),and the levels of Hs-CRP were determined by immune turbidimetric test. All cases were followed up for 6 months, recorded the major adverse cardiovascular events (MACE), including non-fatal myocardial infarction, heart failure, angina pectoris or failure to the hospital,cardiac sudden death.The dynamic changes of serum visfatin and Hs-CRP and its correlation were detected.The difference of the visfatin peak(at the 3th day) of three groups were detected.The relationship between visfatin peak and MACE were analyzed.Results:The levels of serum visfatin at 12th hour,3th day,7th day and 14th day after chest pain onset with ACS patients were(7.20±0.48)ng/mL, (12.20+1.71)ng/mL,(6.43+1.01)ng/mL and (3.57±0.77)ng/mL. The serum visfatin levels at 12th hour,3th day,7th day and 14th day were significantly higher than control group (2.27±0.20) ng/mL, the differences had statistical significance (P<0.01).And the 3th day serum visfatin level was significantly higher than other three moments, the differences had statistical significance(P<0.01).The levels of serum Hs-CRP at 12th hour,3th day,7th day and 14th day after chest pain onset with ACS patients were (10.09±0.49)ng/mL,(17.10±1.37)ng/mL, (10.93±1.16)ng/mL and (2.34±0.65)ng/mL.The serum Hs-CRP levels at 12th hour,3th day,7th day and 14th day were significantly higher than control group (1.93±0.58) ng/mL,the differences had statistical significance(P<0.01).And the 3th day serum Hs-CRP level was significantly higher than other three moments, the differences had statistical significance (P<0.01).There were a positive linear correlation between serum visfatin levels and serum Hs-CRP levels at the same time of 12th hour,3th day,7th day and 14th day (r=0.638,0.600, 0.479,0.529 P<0.05).The level of serum visfatin at 3th day were respectively STEMI group(13.46±1.14)ng/ml,NSTEMI group(12.49±0.83)ng/ml,UAP group(9.89±0.90)ng/ml, the serum visfatin level of STEMI group was significantly higher than other two groups, the differences had statistical significance (P<0.01). Compared to UAP, resistin levels were elevated in patients with NSTEMI and STEMI,The difference had statistical significance, (P<0.01). Compared to UAP group(5%),the incidence of MACE in the 6 months were higher with STEMI group(13.33%)and NSTEMI group (10%). The difference of visfatin levels had statistical significance between two groups whether with MACE(14.43±1.38ng/ml vs 11.95±1.56 ng/ml, P<0.01). Conclusion:1 The level of serum visfatin and serum Hs-CRP at 12th hour,3th day,7th day and 14th day of ACS onset were significantly raised than control group, the 3th day were the highest. With the development of ACS, the levels of serum visfatin and serum Hs-CRP have dynamic variation. The level of serum visfatin and serum Hs-CRP have a positive correlation, it showed that they may work together in the inflammatory reaction of ACS.2 The level of serum visfatin in the STEMI group was significantly higher than NSTEMI group and UAP group at 3th day, and the level of serum visfatin in NSTEMI group was significantly higher than UAP group,suggested that the correlations between the correlation serum visfatin level and severity of coronary disease.3 The incidence of MACE in STEMI group,NSTEMI group and UAP group was no obvious difference,may be related to the small sample.in the 6 months,The level of serum visfatin of patients with MACE was significantly higher than patients with no-MACE. It demonstrated that the visfatin was a negative factor which leaded to the occurrence of MACE and worsened prognosis.
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