The Clinical Value Of Phosphoglucomutase Activity In Acute Coronary Syndrome

BackgroundCoronary artery disease (CAD) also known as atherosclerotic heart disease, coronaryheart disease (CHD), or ischemic heart disease (IHD), is the most common heartdisease as well as cause of heart attacks. CHD is caused by plaque building up alongthe inner walls of the arteries ofheart, as the plaque narrows the arteries and reducesblood flow to the heart. Atherosclerosis of coronary (As) is the underlying cause ofalmost all of ischemic heart disease. On the basis of As, plaque rupture andthrombosis are the possible causes of life-threatening acute coronary syndrome(including unstable angina and acute myocardial infarction). Coronary heart disease isthe world’s leading cause of death in2012, and one of the main causes ofhospitalization. As a result, to early identify people with high risk of CHD and todiagnose CHD with the help of CHD associated biomarker has become a researchhotpot. So far, the study of biological markers for diagnosis, assessment, riskstratification, prognosis and other aspects of CHD or ACS is fairly mature andprofound. A variety of biomarkers are applied to demonstrating and revealing therelevance between themselves and the occurrence or development of CHD from allaspects of the pathophysiology of the disease, including inflammation, oxidativestress, myocardial injury and necrosis, immune, coagulation, etc. These biomarkersare important to the diagnosis and treatment and management of coronary heartdisease. However, detection of single biomarker has its limitation because singlebiological marker only reflects a certain stage of the development of the disease.Therefore many domestic and foreign experts and scholars have recommended theapplication of combination of various kinds of biomarkers for the diagnosis of CHD,in order to evaluate the patient’s condition roundly and give an effective targetfor treatment. Phosphoglucomutase is a key enzyme in the metabolic pathwaycatalyzing the interconversion of glucose-1-phosphate (G-1-P) andglucose-1-phosphate (G1P). In recent years, some scholars found that PGM activity inoperation group was higher than that of sham operation group during conducting therats models of drug-induced arterial thrombosis, and suggested that the elevation ofPGM is correlated with inflammation, stress and thrombosis by arterial injured.Clinical research later showed that PGM activity in acute myocardial infraction groupwas significant higher than that in normal control and was well correlated with otherestablished CHD related biomarkers, which suggests that PGM as a novelbiomarkercan be applied to diagnosis, assessment, prognosis of CHD.ObjectiveThe purpose of this study is to investigate the clinical value ofphosphoglucomutase activity in acute coronary syndrome.MethodsInthisstudy,84patients(57males,27females)with chest tightness or chestpainadmittedtocardiovasculardepartmentofSecondAffiliatedHospitalofGuangzhouMedicalUniversityfromMay2013toNovember2013areselectedasresearchsubjectsbymeansof"case-control".Takingcoronaryarteriographyasthe"goldenstandard"inspectionmethod,patientscanbediagnosedasACSwhentheirangiographyresultsshowsthat1)thestenosisofatleastoneofthefollowingcoronaries,ie.leftmaincoronaryartery,leftanteriordescendingartery,leftcircumflexartery,rightcoronaryarteryisgreaterthanorequalto50%byatleasttwoorthogonalprojectionposition,2)positiveresultofmedicalhistory,electrocardiogram,markersofmyocardialnecrosisandsoon.Andthepatientswhoseangiographyresultisnegativeweresettocontrolgroup.The66-peopleACSgroupconsists23ST-segmentelevationmyocardialinfarction,23NonST-segmentelevationmyocardialinfarctionand20unstableangina， andthereare18peoplewithnormalresultinthecontrolgroup.Fastingperipheralvenousbloodsampleofallpatientsweredrawnwithin24hoursafteradmission.PartofbloodsampleweresenttoclinicallaboratoryforthedetectionofcreatinekinaseisoenzymeMB,troponinI,creatinine,B-typenatriureticpeptide,glycatedhemoglobin,high-sensitivityC-reactiveprotein,totalcholesterol,low-densitylipoproteincholesterol,highdensitylipoproteinproteincholesterol,therestofthebloodsamplewerecentrifugedtogetserum,whichwereusedfordetectionofPGMandLp-PLA2bymeansofELISA.StatisticalmethodswereusedforcomparingthedifferenceofPGMactivitybetweenACSgroupandcontrolgroup,withvarioussubtypeofACS,differentnumbersofcoronarylesionsanddifferentlevelofSYNTAXscore.ReceiveroperatingcharacteristiccurvewasusedtoevaluatethediagnosticvalueofPGMactivityforACSandAMI,andalsotoexplorethediagnosticthreshold.CorrelationanalysisofPGMactivity,establishedbiomarkersandSYNTAXscorewasconducted.Results1. The mean of PGM activity of control group is20.08±11.98U/L, UA group,27.50±21.46U/L, NSTEMI group,67.52±40.83U/L and STEMI group101.57±95.14U/L. The differences of PGM activity between1) control group&NSTEMI (P＜0.01) group and2) control group&STEMI group (P＜0.01) are both statisticallysignificant, whereas the difference of PGM activity between control group&UAgroup isn’t statistically significant (P=0.682). The differences of PGM activitybetween1) UA group&NSTEMI (P=0.02) group and2) UA group&STEMI group(P＜0.01) are both statistically significant.The difference of PGM activity betweenNSTEMI group&STEMI group (P=0.04) is statistically significant.2. Receiver operating characteristic curve was used to evaluate the diagnosticvalue of PGM activity for ACS. The result shows that AUC for ACS is0.833(cut-offvalue31.371U/L) and that for AMI is0.894(cut-off value34.851U/L). AUC of PGMcombined with Lp-PLA2for ACS is0.994(95%CI:0.984-1.000，P value＜0.05) 3. The differences of PGM activity among different numbers of pathologicalcoronary vessel(1,2,3) and different groups of SYNTAX score (＜22,≥22) showno statistical significance.4. Correlation analysis shows that there’s no obvious correlation between PGMactivity and LDL-CH, HDL-CH, CHOL,Hb1Ac,creatinine,B-typenatriureticpeptideand SYNTAX score(r=0.036，P＞0.05),whereas correlation analysis show that there are linear relationship between PGMactivity and1) Lp-PLA2(r=0.449，P＜0.01),2) CK-MB(r=0.495，P＜0.01),3)hs-CRP(r=0.372，P＜0.01) and4) cTnI(r=0.649，P≤0.01).ConclusionElevated serum phosphoglucomutase activity is observed in acute myocardialinfarction, whereas there is no significant increase in unstable angina pectoris. PGMmight be a potential biomarker in the diagnosis of AMI.