Serum STLT-1 and bilirubin levels in patients with acute coronary syndrome and correlation with prognosis

Transcription

1 EXPERIMENTAL AND THERAPEUTIC MEDICINE Serum STLT-1 nd bilirubin levels in ptients with cute coronry syndrome nd correltion with prognosis RONG FU 1, XU SONG 2, DEXING SU 3, SHUNRONG LI 4, LIZHEN GAO 5 nd CHUNMEI JI 6 Deprtments of 1 Crdiology nd 2 Respirtory Medicine, People's Hospitl of Rizho, Rizho, Shndong ; Deprtments of 3 Crdiology, 4 Criticl Cre Medicine nd 5 Clinicl Lbortory, People's Hospitl of Zhngqiu, Jinn, Shndong ; 6 Deprtment of Clinicl Lbortory, People's Hospitl of Weifng, Weifng, Shndong , P.R. Chin Received September 20, 2017; Accepted Mrch 29, 2018 DOI: /etm Abstrct. The serum triggering receptor expressed on myeloid cell (TREM)-like trnscription fctor-1 [soluble TREM-like trnscript-1 (STLT-1)] nd bilirubin levels were investigted in ptients with cute coronry syndrome nd the correltion with prognosis. A totl of 125 ptients of cute coronry syndrome dmitted to the Deprtment of Crdiology in People's Hospitl of Rizho were selected, including 45 cses with ST-segment elevtion myocrdil infrction (STEMI), 36 cses with non-st-elevtion myocrdil infrction (NSTEMI) nd 44 cses with unstble ngin pectoris (UAP), while 48 subjects were enrolled s the norml control. The serum STLT-1 nd bilirubin levels on dmission nd on the 3rd, 7th nd 10th dy fter dmission of ptients in ech group were respectively determined, the level chnges of these two indictors in serum during the initil stge of cute coronry syndrome were nlyzed, nd their effects on prognosis of ptients were nlyzed. STLT-1 levels in groups STEMI, NSTEMI nd UAP were higher thn those in the norml control group, nd serum levels of STLT-1 in groups STEMI nd NSTEMI were higher thn those in group UAP. Bilirubin levels in groups STEMI, NSTEMI nd UAP were lower thn those in the norml control group, nd serum levels of bilirubin in groups STEMI nd NSTEMI were lower thn those in group UAP. The proportions of complictions in ptients of groups STEMI nd NSTEMI were significntly higher thn those in group UAP (P<0.05). The results showed tht the timely nd effective tretment dministered to ptients with cute coronry syndrome during the initil stge to reduce the level of STLT-1 in serum nd enhnce bilirubin to reltively high level is conducive in meliorting the prognosis of ptients, which is of clinicl significnce. Correspondence to: Dr Chunmei Ji, Deprtment of Clinicl Lbortory, People's Hospitl of Weifng, 151 Gungwen Street, Kuiwen, Weifng, Shndong , P.R. Chin E-mil: cxm4gh@163.com Key words: cute coronry syndrome, STLT-1, bilirubin Introduction In recent yers, with the grdul geing of the popultion nd the chnge of dietry hbits in Chin, the incidence of crdiovsculr disese hs incresed grdully. Coronry hert disese hs received most ttention from medicl workers becuse of its high ftlity rte, especilly the cute onset of coronry hert disese (1,2). Acute coronry syndromes minly include ST-segment elevtion myocrdil infrction (STEMI), non-st-elevtion myocrdil infrction (NSTEMI) nd unstble ngin pectoris (UAP). At present, coronry ngiogrphy is regrded s the gold stndrd in the dignosis of coronry hert disese, which hs the disdvntges of high cost nd inconvenience. Thus, it is crucil to conduct the erly dignosis nd effective tretment by combining with enquiry bout ptients' medicl history, s well s physicl nd lbortory exmintion (3-5). STLT-1 hs common genetic origin with the triggering receptor expressed on myeloid cells (TREM), which is nturl immune receptor ctivted by ssocited receptor proteins. Bilirubin is bile pigment, which is the min metbolite of iron porphyrin compounds in vivo. It hs ntioxidnt function nd cn inhibit the oxidtion of linoleic cid nd phospholipids. In this study, the serum soluble TREM-like trnscript-1 (STLT-1) nd bilirubin levels in ech group of ptients were determined, so s to estimte the erly dignosis nd prognosis. Ptients nd methods Generl dt. A totl of 125 ptients of cute coronry syndrome nd 48 cses with norml coronry ngiogrphy dmitted to People's Hospitl of Rizho (Rizho, Chin) from Jnury 2015 to September 2016 were selected, nd ll of them met the stndrds in the guidelines of the Americn College of Crdiology nd the Americn Hert Assocition for coronry syndromes in 2012 (6). There were 45 cses with STEMI, 36 cses with NSTEMI nd 44 cses with UAP. The selected ptients hd no severe cute or chronic infection, orgn dysfunction or mlignncy. The sttisticl nlysis reveled tht there were no significnt differences in ge, sex, dietry hbit nd blood lipid mong the ptients dmitted to the hospitl (Tble I), indicting tht the dt were comprble.

2 2 FU et l: STLT-1 AND BILIRUBIN LEVELS IN PATIENTS WITH CORONARY SYNDROME Tble I. Comprison of generl dt mong the four groups. Generl dt Group STEMI Group NSTEMI Group UAP Group norml control χ 2 /t P-vlue Totl Sex (%) Mle Femle Age (yers) 57± ± ± ± Cholesterol (mmol/l) 6.12± ± ± ± STEMI, ST-segment elevtion myocrdil infrction; NSTEMI, non-st-elevtion myocrdil infrction; UAP, unstble ngin pectoris. Tble II. Comprison of serum levels of STLT-1 between nd fter tretment in ech group of ptients (pg/ml). STLT rd dy 7th dy 10th dy Groups Cses (no.) At dmission fter tretment fter tretment fter tretment F P-vlue STEMI ± ± c 361.2± c 225.9±73.2 -c 8.05 <0.05 NSTEMI ± ± c 322.5±98.2 -c 213.1±76.1,c 8.16 <0.05 UAP ± ±132.7,c 276.3±85.1,c 156.2±55.4,c 8.22 <0.05 Norml control ± ±85.3 c 112.4±41.5 c 85.1±33.8 c 8.21 <0.05 F P-vlue >0.05 <0.05 <0.05 <0.05 Compred with the norml control group, sttisticlly significnt difference, P<0.05; b Compred with the group UAP, sttisticlly significnt difference, P<0.05. c The vlue t ech time point is different from tht t the previous point, nd sttisticlly significnt, P<0.05. STLT-1, soluble TREM-like trnscript-1; STEMI, ST-segment elevtion myocrdil infrction; NSTEMI, non-st-elevtion myocrdil infrction; UAP, unstble ngin pectoris. The study ws pproved by the medicl Ethics Committee of People's Hospitl of Rizho, nd the ptients or their fmilies signed informed consent. Methods. Venous blood (3 ml) ws collected using vcuum nticogultion blood collection tube from the ptients on dmission. Ptients in STEMI, NSTEMI nd UAP groups were treted with spirin (Byer AG, Leverkusen, Germny) t dose of 100 mg Qd nd clopidogrel (Snofi S.A., Pris, Frnce) t dose of 75 mg Qd. Fsting blood ws extrcted from ech ptient on the 3rd, 7th nd 10th dy fter tretment. Serum levels of STLT-1 were determined using ELISA kit (Oumeng, Biotechnology Co. Ltd., Beijing, Chin). An ADVIA1800 utomtic biochemicl nlyzer ws used to determine serum bilirubin levels (Siemens, Berlin, Germny). The ptients were followed up by telephone for yer t regulr intervls fter dischrge. The prognosis of the ptients ws nlyzed. Sttisticl nlysis. Sttisticl Product nd Service Solutions (SPSS) 17.0 softwre (SPSS, Inc., Chicgo, IL, USA) ws used for sttisticl nlysis. Mesurement dt re expressed s men ± stndrd devition. The nlysis of vrince ws dopted for comprison mong the groups nd the post hoc test used ws Dunnett test, nd t-test ws utilized for comprison between the groups. The Chi-squre test ws used for enumertion dt. P<0.05 ws set s the test level. Results Comprison of serum levels of STLT-1 before nd fter tretment in ech group of ptients. At dmission, there were no sttisticlly significnt differences in serum STLT-1 mong the groups (P>0.05). Compred with the norml control group, the serum levels of serum STLT-1 in groups STEMI, NSTEMI nd UAP were higher, nd the differences were sttisticlly significnt (P<0.05). Moreover, the serum STLT levels in groups STEMI nd NSTEMI were higher thn those in group UAP, nd the differences were sttisticlly significnt (P<0.05). There ws no sttisticlly significnt difference in comprison with serum STLT-1 level between groups STEMI nd NSTEMI (P>0.05). With the prolongtion of tretment time, STLT-1 level in groups STEMI, NSTEMI nd UAP ws decresed (P<0.05), nd the vlue t ech time point ws different from tht t the previous point, which ws sttisticlly significnt (Tble II).

3 EXPERIMENTAL AND THERAPEUTIC MEDICINE 3 Tble III. Comprison of serum levels of bilirubin between nd fter tretment in ech group of ptients. Bilirubin rd dy 7th dy 10th dy Groups Cses (no.) At dmission fter tretment fter tretment fter tretment F P-vlue STEMI ± ±3.21 -c 13.68±2.84 -c 15.42±2.54 -c 8.78 <0.05 NSTEMI ± ±2.58 -c 14.31±2.73 -c 15.67±2.21 -c 8.84 <0.05 UAP ± ±2.42,c 15.24±2.42,c 15.89±2.16,c 9.02 <0.05 Norml control ± ±1.89 c 16.63±1.92 c 16.72±1.95 c 9.21 <0.05 F P-vlue >0.05 <0.05 <0.05 <0.05 Compred with the norml control group, sttisticlly significnt difference, P<0.05; b Compred with the group UAP, sttisticlly significnt difference, P<0.05. c The vlue t ech time point is different from tht t the previous point, which is sttisticlly significnt, P<0.05. STEMI, ST-segment elevtion myocrdil infrction; NSTEMI, non-st-elevtion myocrdil infrction; UAP, unstble ngin pectoris. Tble IV. Comprison of complictions in the three groups of ptients with cute coronry syndrome [n (%)]. Groups Cses (no.) Myocrdil infrction Intrctble ngin pectoris Deep vein thrombosis Crdic deth STEMI 45 6 (13.3%) 9 (20%) 4 (8.9%) 2 (4.4%) NSTEMI 36 5 (13.8%) 8 (22.2%) 4 (11.1%) 2 (5.6%) UAP 44 3 (6.8%) 13 (29.5%) 2 (4.5%) 1 (2.3%) χ P-vlue <0.05 <0.05 <0.05 <0.05 Compred with the group UAP, sttisticlly significnt difference, P<0.05. STEMI, ST-segment elevtion myocrdil infrction; NSTEMI, non-st-elevtion myocrdil infrction; UAP, unstble ngin pectoris; DVT, deep vein thrombosis. Comprison of serum levels of bilirubin before nd fter tretment in ech group of ptients. At dmission, there were no sttisticlly significnt differences in serum bilirubin mong the groups (P>0.05). Compred with the norml control group, the serum levels of serum bilirubin in groups STEMI, NSTEMI nd UAP were lower, nd the differences were sttisticlly significnt (P<0.05). Moreover, the serum bilirubin levels in groups STEMI nd NSTEMI were lower thn those in group UAP, nd the differences were sttisticlly significnt (P<0.05). There ws no sttisticlly significnt difference in comprison with serum bilirubin level between groups STEMI nd NSTEMI (P>0.05). With the prolongtion of tretment time, bilirubin level in groups STEMI, NSTEMI nd UAP ws incresed (P<0.05), nd the vlue t ech time point ws different from tht t the previous point, which ws sttisticlly significnt (Tble III). Complictions in the three groups of ptients with cute coronry syndrome. The comprison in prognosis of the ptients in the lter stge reveled tht the proportions in the occurrence of myocrdil infrction, intrctble ngin pectoris nd deep vein thrombosis (DVT) were significntly incresed in groups STEMI nd NSTEMI compred with those in group UAP, nd the differences were sttisticlly significnt (Tble IV). Discussion Coronry hert disese derives from coronry therosclerosis cused by vrious risk fctors, thus, leding to stenosis or obstruction of the blood vessels, further inducing myocrdil hypoxi, or even infrction (7). In recent yers, with the process of ging nd dietry chnges, the incidence of coronry hert disese in Chin is on the rise. If cute coronry syndrome fils to be dignosed in time nd treted effectively, it will bring gret burden to the fmily nd society due to its extremely high mortlity rte (8). Therefore, the erly dignosis nd tretment of coronry syndrome nd the reduction of certin risk indictors re of gret importnce to rescue the endngered myocrdium nd meliorte the prognosis of ptients with cute coronry syndrome. STLT-1 is protein produced by the clevge of TLT-1 on the surfce of pltelets. When the body hs n inflmmtory response due to vrious resons, the level of STLT-1 in the serum my increse significntly (9,10). Relted studies indicte tht STLT-1 hs promoting role in coronry hert disese. It plys regultory role in pltelets, leukocytes nd endothelil cells, which minly dhere to vsculr endothelil cells by promoting ctin polymeriztion, thus inducing the occurrence of therosclerosis nd promoting the development of coronry hert disese (11,12). The study

4 4 FU et l: STLT-1 AND BILIRUBIN LEVELS IN PATIENTS WITH CORONARY SYNDROME by Espond et l (13) indictes tht STLT-1 is remrkbly elevted in the serum of ptients with cute coronry syndromes. The present study lso confirmed tht serum level of STLT-1 in ptients with cute coronry syndromes ws higher thn tht in controls, which ws consistent with the bove findings. The present study demonstrted tht the serum levels of STLT-1 in groups STEMI nd NSTEMI were higher thn those in group UAP, nd the proportions of complictions in groups STEMI nd NSTEMI were significntly higher thn those in group UAP. In recent yers, the study of bilirubin hs indicted tht it plys n importnt role in crdiovsculr nd cerebrovsculr diseses. Bilirubin is powerful ntioxidnt in the body, nd different types of bilirubin re effective ntioxidnts tht cn scvenge oxygen free rdicls from the body nd protect low-density lipoproteins in the body, in order to resist the dmge to the blood vessel nd reduce the possibility of therosclerosis (14,15). Studies worldwide hve shown tht the level of bilirubin in serum is negtively-relted to the incidence of coronry hert disese (16,17). This study reveled tht the serum bilirubin levels in groups STEMI, NSTEMI nd UAP were lower thn those in the norml control group, nd the serum bilirubin levels in groups STEMI nd NSTEMI were lower thn those in group UAP. The present study indicted tht the serum level of STLT-1 ws elevted with the increse of severity of cute coronry syndrome, which could grdully decrese through the effective tretment, nd ptients with lower STLT-1 level in the group UAP hd reltively low proportion of severe complictions. The bilirubin level ws lower in group STEMI thn tht in the norml control nd UAP groups, which could be grdully enhnced fter tretment, nd ptients with higher bilirubin level in the group UAP hd reltively low proportion of severe complictions. In terms of prognosis, ptients with STEMI nd NSTEMI were more severe thn ptients with UAP. Myocrdil cell dmge ws observed in STEMI nd NSTEMI groups. It is speculted tht the prognosis of STEMI nd NSTEMI is worse thn tht of UAP. Levels of STLT-1 nd bilirubin in STEMI nd NSTEMI groups were lso higher thn those in UAP. However, further studies re needed to investigte the mechnism. Therefore, we believe tht the timely nd effective tretment dministered to ptients with cute coronry syndrome during the initil stge to reduce the level of STLT-1 in serum nd enhnce bilirubin to reltively high level is conducive in meliorting the prognosis of ptients, which hs n importnt clinicl significnce. Acknowledgements Not pplicble. Funding No funding ws received. Avilbility of dt nd mterils The dtsets used nd/or nlyzed during the current study re vilble from the corresponding uthor on resonble request. Authors' contributions RF wrote the mnuscript. RF nd XS were responsible for collecting the clinicl nd lbortory informtion. DS nd SL nlyzed venous blood. LG nd CJ contributed to follow-up nd sttisticl nlysis. All uthors red nd pproved the finl mnuscript. Ethics pprovl nd consent to prticipte The study ws pproved by the medicl Ethics Committee of People's Hospitl of Rizho (Rizho, Chin) nd the ptients or their fmilies signed the informed consent. Consent for publiction Not pplicble. Competing interests The uthors declre tht they hve no competing interests. References 1. Colntonio LD, Gmbo CM, Richmn JS, Levitn EB, Solimn EZ, Howrd G nd Sfford MM: Blck-white differences in incident ftl, nonftl, nd totl coronry hert disese. Circultion 136: , Liu Q, Lichtenstein AH, Mtthn NR, Howe CJ, Allison MA, Howrd BV, Mrtin LW, Vldiviezo C, Mnson JE, Liu S, et l: Higher lipophilic index indictes higher risk of coronry hert disese in postmenopusl women. Lipids 52: , Song P, Wng SX nd Wng JJ: The ppliction vlue of 64 slice spirl CT coronry ngiogrphy in the dignosis of coronry hert disese. J Integr Trdit Chin W Med Cerebrovsc Dis 10: , Anderson L, Brown JP, Clrk AM, Dll H, Rossu HK, Bridges C nd Tylor RS: Ptient eduction in the mngement of coronry hert disese. Cochrne Dtbse Syst Rev 6: CD008895, Svvrsdóttir MH, Sigurðrdóttir ÁK nd Steinsbekk A: Knowledge nd skills needed for ptient eduction for individuls with coronry hert disese: The perspective of helth professionls. Eur J Crdiovsc Nurs 15: 55-63, Jin J: JAMA ptient pge. Testing for silent coronry hert disese. JAMA 312: , Wng BH, Wng H, Yng CZ, Hu KL nd Zhou K: Study on the sttus of dischrge rediness nd its influencing fctors in ptients with coronry hert disese. Chung Hu Hu Li Ts Chih 52: , 2017 (In Chinese). 8. Song Q nd Chen CX: Current sttus of helth self-mngement mong elderly ptients with coronry hert disese in Hebei province. Chin Pub Helth 8: 1-5, Brrow AD, Astoul E, Floto A, Brooke G, Relou IA, Jennings NS, Smith KG, Ouwehnd W, Frndle RW, Alexnder DR nd Trowsdle J: Cutting edge: TREM-like trnscript-1, pltelet immunoreceptor tyrosine-bsed inhibition motif encoding costimultory immunoreceptor tht enhnces, rther thn inhibits, clcium signling vi SHP-2. J Immunol 172: , Morles J, Vill K, Gttis J, Cstro W, Colon K, Lubkowski J, Snbri P, Hunter R nd Wshington AV: Soluble TLT-1 modultes pltelet-endothelil cell interctions nd ctin polymeriztion. Blood Cogul Fibrinolysis 21: , Adukpo S, Gyn BA, Ofori MF, Dodoo D, Velvn TP nd Meyer CG: Triggering receptor expressed on myeloid cells 1 (TREM-1) nd cytokine gene vrints in complicted nd uncomplicted mlri. Trop Med Int Helth 21: , Derive M, Bouzz Y, Sennoun N, Mrchionni S, Quigley L, Wshington V, Mssin F, Mx JP, Ford J, Aluzet C, et l: Soluble TREM-like trnscript-1 regultes leukocyte ctivtion nd controls microbil sepsis. J Immunol 188: , 2012.

5 EXPERIMENTAL AND THERAPEUTIC MEDICINE Espond OL, Hunter R, Del Río JR nd Wshington AV: Levels of soluble TREM-like trnscript 1 in ptients presenting to the emergency deprtment with chest pin. Clin Appl Thromb Hemost 21: 30-34, Zhng XJ, Sun TW, Kn QC, Yo HM, Wn YD, Yo R, Gun FX, Guo CQ, Zhng SG, Sun WJ, et l: Serum totl bilirubin nd long-term outcome in ptients undergoing percutneous coronry intervention. Clin Invest Med 37: E345-E351, Chintnboin J, Hner MS, Sethi A, Ptel N, Tnyous W, Llos A nd Pncholy S: Serum bilirubin s prognostic mrker in ptients with cute decompensted hert filure. Koren J Intern Med (Koren Assoc Intern Med) 28: , Ozturk M, Askın L, Ipek E, Demirelli S, Turn OE, Yıldırım E, Ermis E, Klkn K nd Delice O: The role of serum bilirubin levels in predicting troponin positivity in non-st-segment elevtion cute coronry syndrome. Angiology 68: , Tnındı A, Erkn AF, Alhn A nd Töre HF: Arteril stiffness nd centrl rteril wve reflection re ssocited with serum uric cid, totl bilirubin, nd neutrophil-to-lymphocyte rtio in ptients with coronry rtery disese. Antol J Crdiol 15: , This work is licensed under Cretive Commons Attribution-NonCommercil-NoDerivtives 4.0 Interntionl (CC BY-NC-ND 4.0) License.