| Objective1.To explore the changes of serum CA125levels, mechanism and clinical significance in patients after AMI. and according to its fluctuation we shall assess the condition and guide the treatment of heart failure after AMI;2. It’s better to comprehend the pathophysiology of the heart failure after myocardial infarction from the aspects of systemic and pulmonary circulation fluid overloadMethod118patients were enrolled at the first Affiliated Hospital of Kunming Medical University from december2012to december2013in the study,88cases (mean age62±12years) with AMI was the study group, and30PSVT cases with normal cardiac function was the control group. Venous blood samples were taken at the admission and after48hours from the first taken to check the serum CA125levels. The study and the control group measured the hs-CRP, BNP values and echocardiography at least once。All the patients admitted to AMI did physical examination to distinguish Killip classifications immediately at the admission respectively. And there were10patients in critical condition and lined the deep venous catheter to monitor CVP to guide therapy in the study group.We define the ACA125values as the value that CA1252divided by CA1251at early AMI (acute myocardial infarction in24hours to complete the first CA125check). First, was there statistical significance between ACA125, CA125, BNP values and different killip classifications, and the negative control group? Secondly draw ROC curve to get the cut-off the point of the ACA125, CA125, BNP values in different Killip classifications and LVEF less than50%in AMI patients.and And judged which one is more sensitivity in identifying different Killip classifications and LVEF less than50%. Analyze the correlation between CA125, ACA125and BNP values, hs-CRP.The last is preliminary study and discussion about mechanisms of the elevated serum CA125values in AMI and proposed that whether the CVP and PCWP can predict the possibility changes of serum CA125values. Data analysis using SPSS17.0statistical package, P<0.05was sentenced for the difference was significant.Results1. There are statistical significance between CA125, ACA125values and Killip classifications;2. CA125values AMI after48hour with EF less than50%and killip classification more than II, III grade of the area under the ROC curve respectively was0.898,0.877,0.898, and killip Ⅳgrade is0.797, its moderate diagnosis cut-off point range were more than8.92,7.99,8.92,15.0U/mL in turn;3. ACA125values with EF less than50%and killip classification more than II, III grade of the area under the ROC curve was0.818,0.930,0.958, and killip Ⅳgrade is0.900, its better diagnostic cut-off point range is more than2.75,3.06,7.71,8.85in turn in early AMI;4. BNP values in AMI with EF less than50%and Killip classification more than Ⅱ, Ⅲgrade of the area under the ROC curve was0.876,0.912, and killip Ⅳgrade is0.817, its better diagnostic cut-off point range is more than (560.28-751.81).415.76,1023.58.2218.56pg/mL in turn;5. Accuracy that ACA125identify different killip classifications is better than the CA125and BNP. and BNP identify different EF values less than50%is better than the CA125and ACA125:6. CA125is relation to hs-CRP. BNP. EF (R=0.435.0.660.-0.677. P<0.OGi). ACA125is relation to hs-CRP. BNP, EF (R=0.524,0.559,-0.623, P<0.001).Conclusion1. Serum CA125levels and its variable value depend on cardiac function and the time of post-AMI;2. when CA125values more than8.92,7.99,8.92,15.0U/mL, it suggest that patients EF values less than50%and killip classifications are more than grade II III Ⅳ in turn;3. when ACA125values more than2.75,3.06,7.71,8.85, it suggest that patients EF values is less than50%and killip classifications are more than grade II III IV in turn in the early AMI;4The elevated serum CA125values may be related to fluid overload and congestion caused by heart failure and inflammatory by necrotic materials which activate the mesothelial cells. Myocardial cells don’t synthesize and release CA125, myocardial infarction in itself does not increase the circulating levels of CA-125; The increased CVP may be associated with systemic circulation fluid overload; The increased PCWP may be associated with pulmonary circulation fluid overload. Both of them may be related to the circulating levels of CA-125:5. Accuracy that ACA125values identify different killip classifications is better than the CA125and BNP values, and BNP identify different EF values less than50%is better than the CA125and ACA125.So combination of the ACA125, CA125and BNP may be the best.6. CA125is relation to hs-CRP, BNP, EF (R=0.435,0.660,-0.677, P<0.001). ACA125is relation to hs-CRP, BNP, EF (R=0.524,0.559,-0.623, P<0.001);... |
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