Effects Of Fasting Blood Glucose Levels On The Serum PTX3 Levels In Patients With ACS And Their Correlation With Severity Of Coronary Artery Lesions

Objective: To explore the effects of fasting blood glucose(FBG) levels on PTX3(pentraxin 3) and their correlation with severity of coronary artery lesions in the patients with ACS.Methods: A total of 182 patients with ACS, including 76 patients with UA(unstable angina), 82 patients with STEMI(ST-segment elevation myocardial infarction) and 24 patients with NSTEMI(non-ST-segment elevation myocardial infarction), were enrolled to the study from January 2015 to August 2015 in cardiac center of the Cangzhou central hospital,who were admitted within 12 hours after symptom onset and underwent coronary angiography(CAG). Fasting hyperglycemia was defined as a fasting blood glucose level ?7mmol/L within 24 hours after admission. The patients without DM(diabetes mellitus)history must have the Hb A1c<6.5%. Patients with ACS were classified into 4 groups based on their diabetes history, Hb A1 c and fasting blood glucose levels: Group A(n=53), Non-diabetic patients without fasting hyperglycemia; Group B(n=40), Non-diabetic patients with fasting hyperglycemia;Group C(n=41), Diabetic patients without fasting hyperglycemia;Group D(n=48), Diabetic patients with fasting hyperglycemia.All the patients were underwent clinical and physical examinations. Informed consents were obtained. Age, sex, smoking, BMI, SBP, hypertension, History of MI, stroke, PCI, TG,TC,LDL-C and HDL-C, hs-c Tn I,Medication history, final diagnosis, Killp classification, GRACE score in the 4 groups were recorded in detail. And the differences of the parameters were compared in the 4 groups.FBG and hs-CRP were collected from all patients in the morning after an overnight fasting and then stored blood samples at-80 to measure the PTX3 concentrations.All the patients underwent CAG were recorded the characteristic of coronary artery lesion and calculated the criteria points of all subjects according to the Gensini score. Gensini scores, frequency of diffuse lesions,the number of the pathological arteriers were compared in the 4 groups.According to the differences of the numbers of the pathological arteriers, these patients were divided into 3 subgroubs: single-vessel lesion, double-vessel lesion, three-vessel or left main vessel lesion. Compared the differences of the baseline characteristics of the the 3 subgroubs, levels of FBG and PTX3, hs-CRP among groups were compared.The spearman correlation was separately used to analyze the FBG with Gensini score and PTX3 in all patients.The sensitivity and specificity of FBG and PTX3 in all ACS patients were analyzed by using the receiver operating characteristic curve(ROC) to predict left main or three-vessel lesion.Results: 1 There were no significant differences in the 4 groups regarding the baseline clinical characteristic such as age, sex, BMI, smoking, SBP, history of hypertension, MI, stroke, PCI,TG, TC, LDL-C,HDL-C, and final diagnosis, Medication history((49) >0.05). 2 There was an increase in the frequency of Killp II~IV in patients with fasting hyperglycemia comparaed with the patients without fasting hyperglycemia, whether they had a history of diabetes or not((49) <0.05). 3 The GRACE scores had a significant difference among the 4 groups((49)<0.001). The group B(143±26)and group D(134±33) had higher GRACE scores than the group A(113±26)and group C(114±20). 4 There were significant differences in the 4 groups regarding the blood biomarkers including PTX3, hs-CRP and peak hs-c Tn I((49) <0.01). Patients with fasting hyperglycemia had a higher PTX3, hs-CRP and peak hs-c Tn I levels than the patients without fasting hyperglycemia. The PTX3, hs-CRP and peak hs-c Tn I levels of the group B(non-DM with fasting hyperglycemia) were significantly higher than the group A and group C which without fasting hyperglycemia, and the peak hs-c Tn I levels of group B were higher than group D(DM with fasting hyperglycemia), PTX3 and hs-CRP levels in group D were significantly higher than group A. The inflammatory markers had no significant differences between group B and group D, But the PTX3 and hs-CRP levels in group B were higher than that in group D. 5 Coronary angiography characteristics in the 4 groups 5.1 There was an significant increase in Gensini score in patients with fasting hyperglycemia comparaed with the patients without fasting hyperglycemia, whether they had a history of diabetes or not((49) <0.01). 5.2 Frequentcy of diffuse lesions in diabetic patients with fasting hyperglycemia(group D) were significantly higher than other 3 groups((49) <0.001). 5.3 There were significant difference regarding the numbers of the pathological arteriers in the 4 groups((49) <0.001),there were higher frequency of three-vessel or left main vessel lesion in B group than that in group D. 6 There were no significant differences in the 3 subgroups with respect to the baseline clinical characteristic((49) >0.05).history of DM((49) =0.003), FBG((49)<0.001),PTX3((49) =0.001) and hs-CRP((49)<0.001) had significantly statistical differences in the 3 subgroups. History of DM,FBG, PTX3, and hs-CRP in three-vessel or left main-vessel lesion group were obviously higher than single-vessel lesion group((49) < 0.05). 7 Relationship between FBG, PTX3 and Gensini score 7.1 FBG levels were positive correlation with PTX3(r=0.564,(49) <0.001) and Gensini score(r=0.508,(49) <0.001)in all of the ACS patients. 7.2 FBG levels were positive correlation with PTX3 and Gensini score in the ACS patients without DM(r=0.577,(49) <0.001 and r=0.606,(49) <0.001). 7.3 FBG levels were positive correlation with PTX3 and Gensini score in the ACS patients with DM(r=0.412,(49) <0.001 and r=0.418, P <0.001). 8 Predictive values of PTX3 and FBG for the three-vessel or left main-vessel lesion8.1 Receiver operating characteristic(ROC) curves of PTX3 and FBG for the three-vessel or left main-vessel lesion in all ACS patients revealed that the area under the receiver operating characteristic curves(AUC) were 0.706((49) =0.004) and 0.746((49) =0.001). 8.2 The ROC curves of PTX3 and FBG for the three-vessel or left main-vessel lesion in ACS patients without DM revealed that the AUC were 0.645((49) =0.002) and 0.724((49) <0.001). 8.3 The ROC curves of PTX3 and FBG for the three-vessel or left main-vessel lesion in ACS patients with DM revealed that the AUC were 0.573((49) =0.288) and 0.670((49) <0.013).Conclusion:1 The level of PTX3, Killip classification,GRACE scores are increase, the severity of coronary lesions are more serious in ACS patients with fasting hyperglycemia, whether patients with diabetes or not. The PTX3 levels in nondiabetic patients with fasting hyperglycemia are higher than that in DM patients with fasting hyperglycemia.2 For ACS patients with three-vessel or left main-vessel lesion, the levels of FBG, PTX3,hs-CRP and the DM prevalence were obviously higher than the ACS patients with single-vessel lesion. And FBG is positively associated with PTX3 and severity of coronary lesions,3 For all ACS patients, FBG may be a predictor of three-vessel or left main-vessel lesion, and PTX3 may be a predictor of three-vessel or left mainvessel lesion in nondiabetic patients.