| Objective: To investigate the value of serum cardiac myosin binding protein-C(cMyBP-C) and vascular endothelial growth factor-B(VEGF-B) in the diagnosis andprognosis evaluation of patients with acute myocardial infarction(AMI).Methods: Forty-two patients with AMI were selected as case group in the departmentof cardiology, the Second People’s Hospital of Lianyungang City from august2012tooctober2013, and forty persons of normal physical examination were selected as controlgroup.Elbow venous blood of AMI patients was immediately draw on admission and befordischarge. Among them,elbow venous blood of twenty-three patients was draw again after12h of undergoing emergency percutaneous coronary intervention(PCI). Elbow venousblood was collected when the control group had a medical physical examination.Theconcentrations of serum cMyBP-C and VEGF-B were measured using enzyme-linkedimmunosorbent assay (ELISA) respectively. Chemiluminescence method was used fordeterminating the concentrations of serum cardiac troponin I(cTnI), creatine kinaseisoenzyme MB(CK-MB) and myoglobin(Myo). The concentration differences ofcMyBP-C, cTnI, CK-MB and Myo between AMI group and control group were compared.Correlations between cMyBP-C and cTnI, CK-MB, Myo were analysed in AMI group.The concentration differences of serum cMyBP-C and cTnI were also compared betweenthe control group and AMI patients with the onset time of less than4h. Receiver OperatingCharacteristic(ROC) curve was used to analyse the sensitivity and specificity of cMyBP-Cin diagnosis of AMI. The concentration differences of serum cMyBP-C and cTnI werecompared between12h after PCI and admission. The increased values(△EDV,△M) ofthe left ventricular end diastolic volume(LVEDV), left ventricular mass(LVM) and theoccurrence of major adverse cardiac events(MACE) of the AMI patients were followed upwithin sixty days after discharge. The AMI patients were divided into△EDV≤0group and△EDV>0group,△M≤0group and△M>0group respectively according to the△EDVlevel and△M level. According to MACE occurrence, the AMI patients were divided into the event group and non-event group. The predictive value of VEGF-B concentrationbefore discharge was analysed to left ventricular remodeling(LVR) and MACE afterdischarge. The relationship between MACE and LVR in AMI patients after discharge wasalso analysed.Results:1. The levels of FBG,TC,TG,LDL-C and hs-CRP in AMI group were higherthan those of control group, the HDL-C level in AMI group was lower than that of controlgroup, the differences were statistically significant(P<0.05). There was not significantdifference of average age, BMI, SBP, DBP, BUN, Scr and UA between the two groups(P>0.05).2. In AMI group, the concentrations of serum cMyBP-C, cTnI, CK-MB and Myowere (107.83±45.49)ng/ml,(13.35±11.71)ng/ml,(51.84±27.00)ng/ml and (122.87±35.99)ng/ml respectively. In control group, the concentrations of serum cMyBP-C, cTnI,CK-MB and Myo were (17.74±13.11)ng/ml,(0.028±0.023)ng/ml,(4.31±2.05)ng/ml and(22.23±7.71)ng/ml respectively. The differences between two groups were statisticallysignificant(P<0.001). Correlation analysis showed that the level of cMyBP-C hadpositive correlation with those of cTnI,CK-MB and Myo in AMI group（r=0.876, P﹤0.05;r=0.632,P﹤0.05and r=0.903,P﹤0.05respectively）. For AMI patients with the onsettime of less than4h, the level of serum cMyBP-C [(75.65±17.81)ng/ml, n=10] was higherthan that of the control group [(17.74±13.11)ng/ml, n=40], the difference was statisticallysignificant (P<0.01), but there was not significant difference when comparing the level ofserum cTnI[(0.034±0.014)ng/ml,n=10] and that of the control group[(0.028±0.023)ng/ml,n=40]（P>0.05）. ROC curve analysis showed that the sensitivity and specificity were83.3%and100%in the diagnosis of AMI when using the level of serum cMyBP-C at68.57ng/ml and the area under ROC curve was0.994. For AMI patients with the onsettime less than4h,the sensitivity and specificity of cMyBP-C were higher than those ofcTnI in the diagnosis of AMI（the areas under ROC curve of cMyBP-C and cTnI were0.989and0.660respectively）.After12h of emergency PCI, the level of cMyBP-C[（57.42±29.01）ng/ml, n=23] was lower than that on admission [（128.50±44.32）ng/ml,n=23],but the level of cTnI[（33.12±7.80）ng/ml,n=23] was higher than that onadmission（[6.45±3.96）ng/ml, n=23], the differences were statistically significant (P<0.01). 3. According to the results of the follow-up, the concentration of serum VEGF-B of△EDV≤0group [(110.61±38.29)ng/ml, n=24] was significantly higher than that of△EDV>0group [(67.74±24.32)ng/ml,n=16],the concentration of serum VEGF-B of△M≤0group[(112.46±39.91)ng/ml,n=22] was significantly higher than that of△M>0group[(70.24±23.17)ng/ml,n=18],the concentration of serum VEGF-B of the MACE group[（53.73±15.70）ng/ml, n=15] was significantly lower than that of non-MACE group[（111.95±33.16）ng/ml, n=27], the differences were statistically significant(P<0.01). Theincidence of MACE of LVR group(100%) was higher than that of non-LVR group(7.14%),the difference was statistically significant(P<0.01).Conclusions:1. The concentrations of serum cMyBP-C,cTnI,CK-MB and Myo inAMI patients were significantly higher than those of control group on admission and theconcentration of serum cMyBP-C had positive correlation with those of cTnI,CK-MB andMyo. cMyBP-C started to rise in4h and had high sensitivity and specificity in thediagnosis of AMI.These suggest that cMyBP-C can be used as early biochemical marker inthe diagnosis of AMI.2. The level of serum cMyBP-C decreased obviously after12h undergoing emergencyPCI in AMI patients. This suggests that cMyBP-C can be used as an early indicator forevaluating the effect of PCI.3. For AMI patients,the lower concentration of serum VEGF-B before discharge, themore LVR obviously after discharge. Low level of VEGF-B predicts LVR after AMI.4. For AMI patients,the lower concentration of serum VEGF-B before discharge, thehigher incidence of MACE after discharge. The concentration of serum VEGF-B beforedischarge can be used as a prediction index of MACE occurrence after discharge. |
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