Studies On Change Of Serum Complement Proteins And It’s Relationship With Prognosis In The Patients With Acute Myocardial Infarction

Objective:Myocardial ischemia is the major reason in acute myocardial infarction (AMI). But inflammatory response, especially complement system activation also plays an important role in myocardial injury. The aim of this study is to examine the change of complement C3, C4, C5b-9and high-sensitivity C-reactive protein (hs-CRP) in patients with AMI and assess the relationship between the levels of serum complement and prognosis.Method:110acute myocardial infarction patients adminited to cardiovascular department in Tianjin Union Medical Center from February2011to December2012were included. The diagnoses of patients were established according to the guideline of myocardial infarction of ESC, ACCF, AHA and WHF in2007.33healthy subjects were selected as control group in medical examination center of the same hospital. Age, gender, weight, height, blood pressure, past medical history, personal history, family history and LVEF were taken. All patients were collected fasting vein blood (3ml) on admission or the next day, and were collected another three blood samples (3ml) separately at the24th hours,3rd days,7th days after onset of chest pain. All controls were also collected fasting vein blood (3ml). The fasting blood samples of the patients were detected blood glucose, glycosylated hemoglobin, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein and fibrinogen. The blood samples of the24th hours were detected levels of NT-proBNP, CKMB and TnT. The blood samples of the24th hours, the3rd and the7th days were detected levels of C3, C4, C5b-9and Hs-CRP. C3, C4and Hs-CRP were detected by nephelometry, and C5b-9was measured by enzyme immunosorbent assay, and CKMB was tested by immune suppression method, and TnT was determined by electrochemical luminescence method, and NT-proBNP was measured by radioimmunoassay. The controls were also detected these indexes. The patients were followed up within90days by outpatient service, and MACE events were records.Result:1. In the AMI group, the serum levels of hs-CRP, C3, C4and C5b-9were significantly increased (P<0.05) at the24th hours than the control subjects. the serum levels of hs-CRP, C3, C4and C5b-9were significantly higher on the3rd days than at the24th hours (P<0.05). On the7th days, the levels were fell significantly (P <0.05).2. In the AMI group, the peak levels of C3, C4, C5b-9had a positive correlation with CKMB, TnT (P<0.05), but had no such correlation with NT-proBNP, LVEF. There was no linear correlation between the levels of hs-CRP and peak levels of CKMB, TnT, NT-proBNP, LVEF.3. The AMI group was divided into anterior subgroup and non anterior subgroups. The peak levels of C3, C4, C5b-9, CKMB and TnT were significantly higher in the anterior subgroup (P<0.05), but hs-CRP in two subgroups had no significant differences. The AMI group was stratified into adverse event subgroup and non adverse event subgroup. The peak levels of C3, C4, C5b-9and hs-CRP were significantly higher in the adverse event subgroup (P<0.05). In addition, incidence of MACE events was significantly higher in the anterior subgroup and the non PCI treatment subgroup (P<0.05).Conclusion:1. In the AMI patients, dynamic change of the C3, C4, C5b-9and Hs-CRP levels was observed, and reached the peak on the3rd day. It suggested that an inflammatory response and complement system activation were appeared at the acute stage of myocardial infarction.2. The peak levels of C3, C4, C5b-9had significant positive correlations with CKMB and TnT, but had no such correlation with NT-proBNP and LVEF. It suggested that the levels of complements were associated with the severity of the disease.3. The peak levels of C3, C4, C5b-9and the incidence of MACE within90day in the anterior AMI patients were significantly higher than that in the non anterior AMI patients. The patients suffered from the adverse event had higher levels of C3, C4, C5b-9and hs-CRP than the other patients. It suggested that the levels of complement proteins would be potential predictor of the disease prognosis as well as hs-CRP.