An Analysis Of The Relationship Of Serum Lp-PLA2 And ESM-1 With Acute Coronary Syndrome

Background:Acute coronary syndrome(ACS)is a critical and dangerous cardiovascular disease which is mainly caused by the imbalance between the supply of blood and the demand of the coronary artery,then a series of symptoms and signs are appeared gradually because of the long-time of hypoxia of myocardial cells.The basis pathological changes of acute coronary syndrome are artery atheromatous plaque erosion,rupture and thrombosis,which cause coronary artery begin to stenose and occlude.The medical science found that inflammatory mechanisms play a critical role in the initiation and development of atherosclerosis in recent time.With the improvement of Chinese people’s living standards and the emergence of dietary imbalance,the incidence of ACS is gradually increasing and the patient’s age is gradually getting younger.Compared with STEMI,the morbidity and death rate of NSTEACS show a significant upward trend,which means the necessary and meaning to detect and treat timely of ACS.There is no specific cytokine marker can be used to prompt the ACS events occur in clinical application.The medical community is keeping studying various cytokines that involved in atherosclerotic plaques,which including lipoprotein associated phospholipase A2(Lp-PLA2)and endothelial cell specific molecule 1(ESM-1).Lp-PLA2 is a new blood factor that reflects to the stability of atherosclerotic plaques in patients with coronary heart disease.It is mainly secreted by smooth muscle cells,endothelial cells and macrophages,and regulated by inflammatory mediators,which is recognized as one of the specific molecules that promote vascular inflammation.Lp-PLA2 produces lipid-proinflammatory substances such as hemolytic phosphatidylcholine and oxidized free fatty acids by interacting with various lipids in the blood,promoting the progress of atherosclerosis.Endothelial cell-specific molecule 1(ESM-1),also known as Endocan,is a latest discovered indicator of endothelial dysfunction.It is a soluble proteoglycan secreted by endothelial cells in blood circulation.A large number of experimental studies have confirmed that ESM-1 can be involved in the molecular signal transduction mechanism of inflammatory cells,leading to endothelial dysfunction,and further promoting the occurrence of atherosclerosis,which is considered as an early indicator of endothelial dysfunction.The purpose of this study is to investigate the difference of Lp-PLA2 and ESM-1 in patients with acute coronary syndrome and patients with stable angina pectoris,whether they can be used as a new blood marker for predicting acute coronary syndrome.methods:Sixty-one patients who were hospitalized in the Department of Cardiovascular Medicine of our hospital from September 2020 to January2021 were randomly selected.According to the principle of randomized controlled trial,the patients were divided into two groups,patients with stable angina pectoris and patients with ACS.Vacuum-collected blood was used to extract 3m L of elbow venous blood under fasting state in the morning,and instant blood samples were collected from patients with acute myocardial infarction at admission to detect the levels of ESM-1.Age,gender,smoking and drinking history,hypertension and diabetes data of all patients were recorded,and height,weight and BMI were measured.The total cholesterol(TC),triglyceride(TG),low density lipoprotein(LDL-C),high density lipoprotein(HDL-C),lipoprotein a(Lp a),apolipoprotein A1(ApoA1),Apoprotein B(ApoB),fibrinogen(Fib),serum creatinine(MYO),Creatine kinase isoenzyme(CK-MB),troponin(c Tn I),Lp-PLA2,were detected in the hospitalized patients were recorded.The above recorded are saved to analysis.results:By statistical analysis,in the two groups,LDL-C(2.36±0.85 vs2.93±0.94mmol/L,P<0.05),Lp-PLA2(64.10±27.86 vs 105.50±54.88 ng/ ml,P <0.01)have statistical difference.It is obvious that the average serum level of Lp-PLA2 in ACS group is significantly higher than stable angina pectoris group.The average serum level of ESM-1(12.325±3.812vs11.687±3.162ng/ml,P>0.05)is not significant between the two groups.There is no statistical significance in gender,age,body mass index,history of hypertension,history of diabetes,and history of smoking between the two groups.Also as the same as TC,TG,HDL-C,Lp a,ApoA1,ApoB,serum uric acid,Fib,and ESM-1.In addition,we found that Lp-PLA2(OR value 1.058,95%IC 1.021-1.097,P<0.01)is significantly associated with ACS,and can be considered as a risk factor for ACS.conclusion:Lp-PLA2,LDL-C are positively correlated with the occurrence of ACS,and Lp-PLA2 is significantly correlated with ACS events,which proves that the increase of Lp-PLA2 can provide highly reference for the occurrence of ACS.ESM-1 is not connected with ACS events.