The Clinical Significance Of Plasma SLOX-1and Bilirubin Change In Acute Coronary Syndrome

BackgroundWith the continuous improvement of people’s living standards, the changes of diet and lifestyle, the aggravation of population aging, the incidence of coronary heart disease coronary heart disease (CHD) increased year by year, which seriously endangered people’s health. Acute coronary syndrome (ACS) was one of the important clinical types. There had been a long time for clinical and basic research in CHD and had a variety of theories. Doctrine of oxidative stress and inflammatory response played a very important position. Oxidative stress could lead to atherosclerosis (AS) and formation of instability plaque through various channels and mechanisms. Oxidative modification of LDL was considered the central link in the atherosclerotic plaque formation now. Vegetal lectin-like oxidized low-density lipoprotein receptor-1(LOX-1) was the specific receptor of oxidized low-density lipoprotein (ox-LDL), which mediated variety biological effects of ox-LDL and played an important role in the formation of unstable plaque and the process of ACS. LOX-1could be hydrolyzed to a soluble form into the circulation. Recent studies had shown that the bilirubin (BIL) had antioxidant effect and was closely related to the occurrence of CHD. In this study, we explored the clinical significance of the plasma level changes of sLOX-1and BIL in patients with ACS, which might provide a new direction for prevention, diagnosis and treatment of ACS.ObjectiveThe serum level expression changes of soluble lectin-like oxidized low-density lipoprotein receptor-1(sLOX-1) and bilirubin (BIL) in patients of the control group and acute coronary syndrome (ACS) group, which included acute myocardial infarction (AMI) group and unstable angina (UAP) group, were measued; The aims were to explore:①The relationship between the plaque stability of ACS and the serum level of sLOX-1and BIL.②the clinical significance of serum level changes of the sLOX-1and BIL in patients in ACS group and diabetes mellitus(DM)+ACSgroup.③the relationship between the the serum level of sLOX-1, BIL and coronary artery lesion counts.④The relationship between the serum level of sLOX-1and low-density lipoprotein cholesterol(LDLc).⑤The correlation between ACS risk factors and ACS.Methods179hospitalized patients were enrolled from Department of Cardiology of the First Affiliated Hospital of Zhengzhou University from December2010to June2011. All of the patients were checked by coronary angiography(CAG),36patients were control group, whose results of CAG were normal(mean age (53.95±9.94)years).143patients were ACS group who were diagnosed by clinical history, electrocardiogram, enzyme and coronary angiography results, which were included98patients of UAP group (mean age (57.84±8.74) yesrs) and45patients of AMI group(mean age (54.93±11.49) years). According to whether diagnosed as DM, ACS group was divided into DM+ACS group and single ACS group.39patients were DM+ACS group (mean age(55.83±9.60) yesrs),104patients were single ACS group (mean age (56.01±8.29) yesrs). We recorded patients’ name, gender, age, blood glucose, bilirubin, high sensitivity C-reactive protein (hs-CRP), high density lipoprotein cholesterol(HDLc), LDLc, triglyceride(TG), total cholesterol, sLOX-1and other indicators. The plasma level of sLOX-1in patients of ACS and control group was measured by enzyme-linked immunosorbent assay.Results①The serum level of sLOX-1was significantly higher in the ACS group than that in the control group (P<0.05), the serum level of total bilirubin(TBIL)、direct bilirubin(DBIL)、indirect bilirubin(IBIL) were significantly lower in the ACS group than that in the control group (P<0.05).②The serum level of sLOX-1, TBIL, DBIL and IBIL among the three groups was significantly different (P<0.01,P<0.01, P<0.01).The plasma level of sLOX-1in the patients of AMI group and UAP group was significantly higher than that in the patients of control group (P<0.05), the serum level of BIL in the AMI group and the UAP group were lower than that in the control group (P<0.05). Even more, the serum level of sLOX-1, TBIL and IBIL between the AMI group and the UAP group was significantly different (P<0.05, P<0.05, P<0.05).③There were significant differences between the DM+ACS group and single ACS group(P<0.05).④The plasma levels of sLOX-1, TBIL and DBIL were not significicantly different among the groups of different coronary attery lesion counts (P>0.05).⑤Relationship analysis showing, the serum level of sLOX-1had no correlation with that of LDLc (P>0.05).⑥Multivariate analysis showing, ACS as the dependent variable, arious clinical factors and the increasing serum level of sLOX-1and the decreasing serum level of BIL as independent variable to do logistic regression analysis showed serum level of sLOX-1(P<0.05) and TBIL(P<0.05) were independent predictors of ACS.Conclusion①With the increasing serum level of sLOX-1and decreasing serum level of BIL, the plaque instability became worse. ②The high serum level of sLOX-land the low serum level of BIL were closely related to the occurrence of cardiovascular disease in diabetes patents.③The serum level of sLOX-1, TBIL and DBIL had no relationship with coronary artery stenosis;④The serum level of sLOX-1had no correlation with that of native LDLc.⑤The different serun level of sLOX-1and TBIL were independent predictors inACS.