Dynamic Changes Of FGF21 In Patients With STEMI Before And After Emergency PCI And Its Correlation With Heart Function

Objective Study on the change of fibroblast growth factor on serum 21 in patients with acute ST segmentelevation myocardial infarction patients undergoing emergency percutaneous coronary intervention.Meanwhile, find out the correlation between serum level of FGF21 and the indexes of heart function in patients after the emergency PCI.Methods1. Research subjects: We chose 108 patients with acute STEMI,(Killip grade I), after full communication with patients, in accordance with the wishes of patients and family members of patients, they were divided into two groups: a total of 76 patients in treatment group, they agreed to accept emergency PCI; 32 patients in the control group, only accepted the conservative medical treatment, the patients refused operation treatment of emergency PCI and signed the informed consent.2. Treatment of AMI: All patients were given standard treatment such as anticoagulant,antiplatelet, lipid-lowering, improving myocardial remodeling treatment. The emergency operation were completed by two experienced interventional cardiologist in our hospital. More than two physicians to evaluate coronary blood flow after operation, the TIMI flow < 3 grade is considered no reflow phenomenon.3. Routine inspection: when admission all patients were detected cardiac markers, blood routine examination, biochemistry, serum creatinine, B-type natriuretic peptide, and ultrasonic cardiogram, et al, meanwhile, we recorded the results detailedly.4. Determination of serum FGF21: Respectively before and after operation of 1 daysand3 days after operation, the treatment were collected venous blood 4ml into the coagulation promoting tubes, after standing for 10 minutes in low temperature,then3000r/min centrifugal 15 minutes, serum was extracted from test tube,then was refrigerated in-80 ℃. The control group were collected venous blood at the corresponding time, serum was obtained by centrifugation. We used the ELISA kit to detect of FGF21.5. Statistic analysis: Continuous variables were expressed as mean ± standard error and categorical variables by the chi-square test. For all analysis, a p value less than 0.05 was considered significant, using a statistical program(spss version 21.0).Results All of the patients didn’t die at the time of admission, and the content of serum FGF21 canaccurately detect. Serum FGF21 level of the patients with acute myocardial infarction increased significantly, then decreased. At the third day after operation, the patients in the treatment group the level of FGF21 was lower than the control group. In all received emergency operation, according to TIMI flow grade, th patients were divided into no-reflow(NR) group and normal reflow group. Serum FGF21 level of the former was slightly higher than the latter(P=0.414), after 1 day, the serum levels of FGF21 in the former were significantly higher than the latter. The patients with nromal flow were divided into combined with diabetes and no diabetes group. The results showed that serum FGF21 level of patients with diabetes is always slightly higher than those without diabetes, but there was no statistical significant difference(P>0.05).In patients with acute STEMI, caused by anterior descending branch, between the level of serum FGF21 at first day after operation and left ventricular ejection fraction at first day after operation shows a significantly negative correlation(R=-0.541, P < 0.001); meanwhile between the level of serum FGF21 at third day after operation and left ventricular ejection fraction at first day after operation shows a significantly negative correlation(R=0.657,P=0.005).At 1th days and 3th days after PCI, between the level of FGF21 in serum and BNP showed a significant positive correlation(R=0.795, P < 0.001; R=0.657, P=0.005).Conclusions The serum level of FGF21 in patients with AMI increased significantly and thendecreased, which does not depend on whether the patient underwent emergency coronary stent implantation. However, the level of serum FGF21 in patients with emergency PCI will earlier return to normal level than who not received emergency PCI. After emergency PCI, the serum FGF21 level of patients with NR was significantly higher than those with normal flow.In STEMI patients caused by anterior descending branch, there was a significant correlation between serum FGF21 level and that indexes can response of left ventricular systolic function, such as EF and BNP.