急性冠脉综合征患者外周血MMP-9及CRP的变化及其临床意义

目的观察急性冠脉综合征（ACS）患者外周血中基质金属蛋白酶-9（m atrix m etalloproteases-9,MMP-9）及C反应蛋白（CRP）的水平变化,探讨MMP-9、CRP与ACS发生的关系。方法选取ACS患者39例,采用双抗体夹心ELISA测定血清MMP-9的水平,CRP用免疫散射比浊法检测。结果ACS患者入院即刻血浆MMP-9、CRP水平均显著高于对照组[（66±16）vs（24±11）μg/L,P<0.01;（12.3±9.2）vs（3.5±2.0）mg/L,P<0.01]。ACS组内UA亚组与AM I亚组比较,MMP-9水平显著增高[（78±11）vs（50±14）μg/L,P<0.01],而CRP水平显著下降[（7.2±2.2）vs（18.7±10.7）mg/L,P<0.01]。ACS组患者中MMP-9和CRP水平无明显相关性。结论冠心病患者外周血MMP-9、CRP水平升高。ACS患者中MMP-9和CRP水平无明显相关性。     

Use of a quantitative point-of-care test for the detection of serum cardiac troponin T in patients with suspected acute coronary syndromes

We compared a third generation quantitative cardiac troponin T (cTnT) point-of-care testing (POCT) from Roche Diagnostics with the laboratory assay (Roche Elecsys 2010 immunoassay analyser). Heparin-treated blood and serum were collected simultaneously in 133 unselected patients (mean age 62 +/- 14 years, 38% females) presenting to our hospital with possible cardiac chest pain. Results of the POCT were measured against the laboratory-based assay considered as the gold standard. There were 18 POCT positive versus 24 laboratory assay positive (> or = 0.03 ng/mL) patients. POCT was falsely negative in six patients, with values between 0.03 and 0.1 ng/mL. The POCT had a sensitivity of 75%, specificity of 100%, positive predictive value of 100%, negative predictive value of 95% and a total accuracy of 95%; kappa = 0.831 (P < 0.001). There was good correlation between the values of POCT and the laboratory assay: Y = 1.195X + 0.002, r2 = 0.94 (P < 0.0001). Whereas cTnT levels > 0.1 mg/mL were reliably detected with this current generation of POCT, cTnT levels between 0.03 and 0.10 ng/mL were not. Future generations of devices will need to improve sensitivity to reliably risk stratify patients with suspected acute coronary syndromes.     

影响急性冠状动脉综合征患者基质金属蛋白酶-9相关因素的研究

目的:观察急性冠状动脉综合征(ACS)患者外周血清可溶性CD40配体(sCD40L)的水平、外周血单个核细胞(PBMCs)中核因子kappa B(NF-κB)的活性及两者与基质金属蛋白酶-9(MMP-9)之间的关系,探讨ACS预测和治疗的新思路。方法:采用酶联免疫吸附法测定所有入选对象外周血清sCD40L、MMP-9的浓度及PBMCs中NF-κB的活性。结果:ACS组外周血清sCD40L的浓度及PBMCs中NF-κB的活性均高于稳定型心绞痛组和正常对照组,均差异有统计学意义(P0.05);ACS组血清sCD40L水平、PBMCs中NF-κB的活性与MMP-9呈显著正相关(P0.01)。结论:ACS患者血清sCD40L水平及PBMCs中NF-κB的活性升高,可能是动脉粥样硬化斑块不稳定的标志之一;CD40L、NF-κB可能通过促使MMP-9的表达增加而促使ACS的发生。     

急性冠脉综合征支架置入后早期血清hsCRP、MMP-9、IL-18的变化及意义

目的观察急性冠脉综合征（ACS）患者冠脉内支架置入前后外周血血清基质金属蛋白酶-9（MMP-9）、IL-18、高敏C反应蛋白（hsCRP）的变化,探讨上述指标对预测支架置入后早期心血管不良事件的价值。方法选择48例ACS患者,根据术后随访结果分为有并发症组和无并发症组,分别于支架置入前、支架置入后24、48h及6个月检测血清hsCRP、MMP-9、IL-18水平。结果患者术后24、48h与术前比较,hsCRP、IL-18显著升高,MMP-9显著降低（P均〈0．05）;有、无并发症组术前上述指标无统计学差异（P均〉0．05）,有并发症组术后24、48h hsCRP、IL-18较术前明显升高,术后6个月血清hsCRP、IL-18较无并发症组显著升高（P均〈0．05）;两组术后24、48h MMP-9水平无统计学差异（P均〉0．05）。结论支架置入后早期并发症的发生与炎症反应有关,术后IL-18、hsCRP持续增高可能成为术后早期并发症的预测因子,术后加强抗炎治疗可预防早期并发症的发生。     

Elevated circulating levels of matrix metalloproteinase-9 and -2 in patients with symptomatic coronary artery disease

BACKGROUND: Matrix metalloproteinases (MMP-9 and MMP-2) have been implicated in development of atherosclerosis and plaque rupture in acute coronary syndromes (ACS). AIM: To determine the relationship between circulating MMPs and symptomatic coronary artery disease. METHODS: Plasma levels of MMP-9 and MMP-2 were measured in patients with ACS, stable angina (SA) and in controls, using a quantitative gelatin zymography. These measurements were correlated with markers of systemic inflammation (hs-CRP) in all subjects and myocardial injury (troponin T) in patients with ACS. RESULTS: Plasma MMP-9 in ACS was greater than in SA, and was greater in SA than in controls (P < 0.01 ACS vs SA and controls, P < 0.01 SA vs control). Plasma MMP-2 was significantly greater in ACS than SA or controls (P < 0.01 vs SA and controls). There was strong overall relationship between hs-CRP and MMP-9 (r = 0.65, P < 0.0001) driven by a significant relationship in ACS patients (r = 0.58, P = 0.02), as there was no significant association in SA or controls. A weaker overall correlation was found between hs-CRP and MMP-2 (r = 0.39, P = 0.02), but no significant relationship was present for either of the two patient subgroups or controls. There was no correlation between levels of troponin T and MMP-9, MMP-2 or hs-CRP in ACS patients. CONCLUSION: Quantitative gelatin zymography identifies increased circulating levels of MMP-9 and MMP-2 in patients with symptomatic coronary disease. MMP-9 and MMP-2 are higher in ACS than SA patients and might have use as markers of plaque rupture or instability. The strong relationship between MMP-9 and hs-CRP in ACS patients suggests MMP-9 might be an additional marker and/or consequence of the inflammatory component in ACS.     

急性冠状动脉综合征患者血清基质金属蛋白酶-9水平变化及意义

目的探讨急性冠状动脉综合征(ACS)患者血清基质金属蛋白酶-9(MMP-9)水平的变化及其临床意义。方法采用酶联免疫分析(ELISA)方法,测定ACS患者、稳定型心绞痛(SAP)患者和健康对照组血清MMP-9水平的变化。结果三组MMP-9分别为(284.30±64.60)ng/ml;(169.80±35.20)ng/ml;(164.40±33.80)ng/ml。三组间比较差异有显著性意义(P<0.001),三组间两两比较,ACS组与SAP组和对照组比较差异有显著性意义(P均<0.001),而SAP组和对照组比较差异无显著性意义(P=0.922)。按SAP、不稳定型心绞痛到急性心肌梗死由轻到重的等级排列,发现MMP-9由低到高的顺序排列,MMP-9水平与冠心病事件的严重程度呈正相关(r=0.762,P<0.001)。结论冠心病患者血清MMP-9水平增高可作为ACS的一个危险信号,同时也可以作为冠心病患者危险分层的一个重要生化监测指标。     

Effects of fluvastatin, an HMG-CoA reductase inhibitor, on serum levels of interleukin-18 and matrix metalloproteinase-9 in patients with hypercholesterolemia

BACKGROUND: Interleukin-18 (IL-18), a novel proinflammatory marker, and matrix metalloproteinase-9 (MMP-9) represent the indices of plaque stability. It is unknown whether hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins), which provide anti-inflammatory and endothelium protection effects, have the property of stabilizing plaque in patients with hypercholesterolemia. HYPOTHESIS: The study was designed to investigate the influence of statin therapy in circulating IL-18, MMP-9, and endothelial function. METHODS: We investigated the effects of a 12-week therapy with fluvastatin on IL-18, MMP-9, and endothelial function in patients with hypercholesterolemia. RESULTS: Compared with placebo, fluvastatin significantly improved flow-mediated vasodilatation to hyperemia, a hallmark of endothelial function [from 3.8% (-3.9 approximately 15.2) to 5.9% (-0.3 approximately 13.2), p = 0.001], and attenuated plasma levels of high sensitivity C-reactive protein (hsCRP) [from 1.3 (0.3 approximately 7.7) to 1.1 mg/l (0.2 approximately 3.5), p = 0.018], IL-18 [from 247.6 (145.4 approximately 378.4) to 196.4 pg/dl (90.7 approximately 380.2), p <0.001], total MMP-9 (from 58 +/- 46.3 to 39.4 +/- 22.4 ng/dl, p = 0.023), and MMP-9 activity [from 6.4 (3.6 approximately 27) to 5.6 ng/dl (3.1 approximately 13.7)]. However, no significant correlation was found between the degree of changes in lipid profile and flow-mediated dilatation (FMD) and plasma concentration of IL-18 and MMP-9. CONCLUSIONS: Fluvastatin reduced plasma concentrations of IL-18 and MMP-9, and improved endothelial function in patients with hypercholesterolemia independent of its lipid-lowering effect.     

阿托伐他汀治疗急性冠脉综合征对血浆MMP-9及GMP-140的影响

目的探讨阿托伐他汀对急性冠脉综合征（ACS）患者血浆基质金属蛋白酶（MMP-9）及血小板α-颗粒膜蛋白（GMP-140）的影响。方法选择60例健康人做对照,200例ACS患者随机分为两组：常规治疗组（未服用任何调脂药物,n=80例）和阿托伐他汀组（10mg/d,n=120例）治疗1周,测定治疗前后MMP-9、GMP-140及血脂水平的变化。结果ACS患者血浆MMP-9、GMP-140水平显著高于健康对照组（P〈0.01）。ACS两组治疗前后血脂各组成分的变化差异均无显著性（P〉0.05）,阿托伐他汀治疗后血浆MMP-9、GMP-140水平明显下降,与治疗前比较有统计学意义（P〈0.01）,但下降程度与TC（r=0.327,P=0.576;r=0.123,P=0.591）,LDL-C（r=-0.312,P=0.921;r=-0.125,P=0.652）的变化无相关性。结论ACS患者早期给予阿托伐他汀强化干预,可明显减少细胞外基质的降解、抗血小板活化及改善内皮功能,对于ACS的临床预后有着重要的意义。     

高敏C-反应蛋白与白介素-6在急性冠状动脉综合征意义

目的 探讨急性冠状动脉综合征(acute coronary symptom,ACS)病人血清高敏C反应蛋白(high sensitivity-C reactive protein,hs-CRP)和白介素-6(interleukin-6,IL-6)浓度的变化及临床意义.方法 ACS组ACS病人60例,稳定型心绞痛(stable angina pectoris,SAP)组病人40例,对照组为40名健康人,检测血清IL-6、hs-CRP水平.结果 ACS组血清IL-6、hs-CRP水平明显高于SAP组和对照组(P＜0.01);ACS组中,急性心肌梗死病人又高于不稳定型心绞痛病人(P＜0.05);SAP组与对照组差异无统计学意义(P＜0.05);血清IL-6和hs-CRP水平呈正相关(r=0.5942,P＜0.01).结论 ACS病人血清IL-6和hs-CRP升高,其水平变化反映ACS的严重程度.     

盐酸替罗非班对急性冠脉综合征hs-CRP和MMP-9的影响

目的观察盐酸替罗非班对急性冠脉综合征（ACS）患者治疗前后血清超敏C反应蛋白（hs-CRP）,基质金属蛋白酶-9（MMP-9）水平的影响,探讨盐酸替罗非班能否抑制斑块炎症反应,及稳定斑块的可能机制。方法55例初诊为ACS的患者随机分为对照组（n=31）和试验组（n=24）,试验组在对照组给予口服阿司匹林,氯吡格雷等常规治疗药物的基础上加用静脉滴注盐酸替罗非班,用超敏乳胶增强免疫比浊法测定ACS患者治疗前后hs-CRP水平,酶联免疫反应试剂盒测定MMP-9水平。结果两组治疗前血清hs-CRP,MMP-9水平未见明显差异;两组治疗后hs-CRP,MMP-9水平均显著下降（P<0.01）;治疗后,替罗非班组下降更显著（P<0.01）。结论盐酸替罗非班能够显著影响血清hs-CRP,MMP-9水平,从而说明盐酸替罗非班亦能通过抑制血管炎症达到稳定斑块的作用。     

急性冠状动脉综合征患者基质金属蛋白酶-9来源的研究

目的:探讨急性冠状动脉综合征(ACS)患者基质金属蛋白酶(MMP)-9的来源.方法:用ELISA法测定75例ACS、28例稳定型心绞痛(SAP)患者外周静脉、冠状动脉罪犯病变近远端血MMP-9水平,14例对照者(CG)则于外周静脉、主动脉根部和冠状静脉窦口采血.结果:①CG组和SAP组各部位血MMP-9水平差异无统计学意义;②ACS组静脉、罪犯病变近端和罪犯病变远端MMP-9水平差异有统计学意义,MMP-9水平病变远端>罪犯病变近端>静脉;③静脉和罪犯病变近端MMP-9水平ACS组显著高于CG和SAP组,而CG与SAP组差异无统计学意义;④罪犯病变远端MMP-9水平ACS组显著高于SAP组;⑤SAP和ACS组静脉MMP-9均与各自病变远端MMP-9水平正相关.结论:ACS患者MMP-9水平的升高主要来源于不稳定斑块的释放;静脉MMP-9可作为检测斑块不稳定的生物学标记物.     

基质金属蛋白酶-9与急性冠状动脉综合征的临床相关性研究

目的:探讨血清基质金属蛋白酶 9(MMP 9)与急性冠状动脉综合征(ACS)的关系。方法:经冠状动脉造影(CAG)确诊的冠心病患者85例,其中ACS患者(ACS组)58例,包括急性心肌梗死(AMI)22例,不稳定型心绞痛(UAP)36例;稳定型心绞痛组(SAP组)27 例;另设对照组 24 例。用酶联免疫吸附法(ELISA)测定各病例造影前及行PTCA者术后血清MMP 9浓度。结果:在造影前,ACS组、SAP组及对照组血清 MMP 9 浓度分别为(26.85±6.25)、(17.35±7.12)、(16.83±5.92)μg/L;此外,ACS组内 AMI和 UAP患者血清 MMP 9 浓度分别为(32.56±6.55)、(24.78±5.76)μg/L。AMI及UAP患者与SAP组之间MMP 9浓度差异有统计学意义,SAP组与对照组之间差异无统计学意义;ACS组内,AMI与UAP患者之间差异无统计学意义。血清 MMP 9 水平与C反应蛋白(CRP)、WBC、冠状动脉病变评分、冠状动脉狭窄程度之间呈明显的正相关,与冠状动脉病变支数、肌钙蛋白 I(cTnI)、肌酸激酶同工酶(CK MB)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL C)、低密度脂蛋白胆固醇(LDL C)、PLT间无明显相关性。PTCA术后 l d MMP 9 浓度均较术前要明显升高。结论:ACS患者血清MMP 9浓度明显升高,其水平与冠状动脉内粥样硬化斑块的稳定性密切相关,提示其有助于冠心病的危险分层,对评价     

Cardiac troponin I for risk stratification following percutaneous coronary artery intervention in acute coronary syndromes.

The cardiac troponins have been shown to provide prognostic information allowing risk stratification of patients with acute coronary syndromes (ACS). The benefit of early percutaneous coronary intervention (PCI) in this setting has been highlighted by the FRISC II study. We assessed the pattern of release of cardiac troponin I (cTnI) following PCI in patients with ACS and evaluated its prognostic value for major adverse cardiac events (MACE): death, Q-wave myocardial infarction (QWMI), and repeat revascularization at follow-up. cTnI was sampled at baseline and 6, 14, and 24 hr following PCI in 73 patients presenting with unstable and post-MI angina. Clinical follow-up was obtained in all 73 patients at a mean period of 43 +/- 19.9 weeks (range, 11-68 weeks). Patients were stratified into two groups according to whether cTnI remained unchanged or fell below baseline 24 hr post-PCI (group 1, n = 47) or increased above baseline 24 hr following PCI (group 2, n = 26). MACE occurred in 4 (8.5%) of patients in group 1 (QWMI = 1, CABG = 1, re-PCI = 2) and in 19 (73%) of patients in group 2 (death = 1, QWMI = 2, CABG = 2, re-PCI = 14; chi-square = 32.34, P < 0.0001). The positive predictive value of rising cTnI within 24 hr following PCI for MACE at follow-up was 0.73 and the negative predictive value was 0.92 (specificity = 83%, sensitivity = 86%; odds ratio = 29.18, 95% CI = 7.62-110.64, P < 0.0001). cTnI is an inexpensive and widely applicable tool that offers reliable prognostic information for the risk stratification of patients undergoing coronary revascularization in the setting of acute coronary syndromes and may identify a group of patients at particular risk of repeat PCI.     

心肌肌钙蛋白I在急性冠状动脉综合征中的应用

急性冠状动脉综合征(ACS)是指不稳定型心绞痛(UA)、Q波型心肌梗死(QMI)、非Q波型心肌梗死(NQMI)和心源性猝死这样一组临床病征。心肌肌钙蛋白I(cTnI)是新近发展的心肌组织所特有的心肌酶学标志物。本文对cTnI的生物化学特点、检测方法、cTnI与ACS的联系进行评价。cTnI在诊断心肌损害方面敏感性高,特异性强,诊断时间窗口宽,明显优于传统心肌酶,对ACS可进行危险度分层及预后评价,并可预测UA患者复杂冠状动脉形态,值得推广使用。     

3种血清指标与老年急性冠状动脉综合征病情程度的相关性研究

目的探讨血清高迁移率族蛋白B1(HMGB1)、基质金属蛋白酶9(MMP-9)、骨膜蛋白与老年急性冠状动脉综合征(ACS)患者病情程度的关系。方法选取老年ACS患者220例,分为急性心肌梗死(AMI)组105例和不稳定性心绞痛(UAP)组115例,另选取健康体检者110例为对照组。对比各组血清HMGB1、MMP-9、骨膜蛋白水平,采用ROC曲线分析预测价值。结果 AMI组和UAP组血清HMGB1、MMP-9、骨膜蛋白水平明显高于对照组,且AMI组较UPA组更高(P<0.05)。血清HMGB1、MMP-9、骨膜蛋白为老年ACS发生的危险因素(P<0.01)。血清HMGB1、MMP-9、骨膜蛋白水平与冠状动脉病变支数(r=0.521,r=0.592,r=0.596,P<0.01)、Gensini评分(r=0.589,r=0.594,r=0.601,P<0.01)、病情程度(r=0.621,r=0.614,r=0.629,P<0.01)呈正相关。ROC曲线分析显示,血清HMGB1预测预后的曲线下面积为0.897,略高于血清MMP-9和骨膜蛋白,差异无统计学意义(P>0.05)。结论血清HMGB1、MMP-9、骨膜蛋白水平是老年ACS发生的重要危险因素,与冠状动脉病变支数、Gensini评分呈正相关,动态检测其水平,可为临床评估病情程度、判断预后提供指导。     

心力衰竭患者血清基质金属蛋白酶及骨桥蛋白、cTnI、cTnT与心室重构的关系

目的研究及观察心力衰竭患者血清基质金属蛋白酶(matrix metalloproteinase,MMP)及骨桥蛋白(osteopontin,OPN)、心肌肌钙蛋白(cardiac troponin,c Tn)I、c Tn T与心室重构的关系。方法选取2012年8月至2014年3月四川省阆中市人民医院收治的70例心力衰竭患者为观察组;另外选择同时期的70名健康人为对照组。将两组的血清MMP及OPN、c Tn I、c Tn T浓度分别进行检测及比较,然后比较观察组不同左心室舒张末期容积指数(left ventricular end-diastolic volume index,LVEDVI)及左心室体积指数(left ventricular mass index,LVMI)患者的上述指标,并以Logistic分析处理上述血清指标与心室重构的关系。结果观察组的血清MMP及OPN、c Tn I、c Tn T浓度均高于对照组,差异有统计学意义(P<0.05);且观察组中不同ΔLVEDVI和LVMI患者上述指标比较,差异有统计学意义(P<0.05)。Logistic分析结果显示,血清MMP及OPN、c Tn I、c Tn T浓度与心室重构均有密切的关系(P<0.05)。结论心力衰竭心室重构患者的血清MMP及OPN、c Tn I、c Tn T浓度呈现异常的状态,上述指标对于心室重构均有较高的反映价值。     

Increased serum activity of matrix metalloproteinase-9 in patients with acute variceal bleeding

Background/Aims

Matrix metalloproteinases (MMP)-2 and -9 can degrade essential components of vascular integrity. The aim of this study was to investigate the association between those MMPs and variceal bleeding (VB).

Methods

Fifteen controls, 12 patients with acute ulcer bleeding (UB) group, 37 patients with varix (V group), and 35 patients with acute VB group were enrolled. Serum was obtained to measure MMP-2 and -9 activity by zymogram protease assays.

Results

The activity levels of these compounds were compared with the controls'' median value. The median MMP-9 activity was 1.0 in controls, 1.05 in the UB group, 0.43 in the V group, and 0.96 in the VB group. The level of MMP-9 activity was higher in the VB group than in the V group (p<0.001). In the VB group, there was a signifi cant decrease in MMP-9 activity over time after bleeding (p<0.001). The median MMP-2 activity level was 1.0 in controls, 1.01 in the UB group, 1.50 in the V group, and 1.55 in the VB group. The level of MMP-2 activity was similar in the VB and V groups.

Conclusions

The level of MMP-9 activity increased in association with VB. The role of MMP-9 in the pathogenesis of VB should be verified.     

辛伐他汀对急性冠状动脉综合征患者早期血浆C-反应蛋白和基质金属蛋白酶-9的影响

目的探讨短期应用辛伐他汀对急性冠状动脉综合征(ACS)患者早期血浆C-反应蛋白(CRP)和基质金属蛋白酶-9(MMP-9)的影响。方法经临床诊断ACS46例,随机分为治疗组和对照组,各23例。对照组给予ACS的一般治疗,不予任何降脂药;治疗组除给予ACS的一般治疗外,加服辛伐他汀40mg/d,共3d。用免疫比浊法和酶联免疫吸附法(ELISA)分别检测2组患者血清CRP和MMP-9。结果2组患者治疗前、后血脂TC、TG、HDL-C、LDL-C的比较差异无统计学意义。2组治疗前和对照组治疗前后的血浆CRP、MMP-9比较差异无统计学意义;治疗组CRP和MMP-9治疗后较治疗前分别下降39.82%和32.39%,均差异有统计学意义(P<0.05)。结论应用辛伐他汀短期治疗ACS患者能够使CRP和MMP-9显著下降,说明他汀类早期应用有抗炎、稳定斑块及防止斑块破裂的作用。     

Value of serial C-reactive protein measurements in non ST-segment elevation acute coronary syndromes

BACKGROUND: Elevated C-reactive protein (CRP) levels at admission are associated with adverse outcomes in patients with non ST-segment elevation acute coronary syndromes (NSTE-ACS). HYPOTHESIS: C-reactive protein measurement not only at admission, but also after admission, may be useful for predicting adverse outcomes in NSTE-ACS. METHODS: We measured high-sensitivity CRP levels at admission and at 24 h in 215 patients with NSTE-ACS. An elevated CRP level at admission (admission elevation) was defined as a CRP level of >/= 0.300 mg/dL. An increase in the CRP level after admission (increase at 24 h) was considered present when the CRP level at 24 h was higher than the level at admission. Patients were divided into 4 groups according to the presence or absence of admission elevation and increase at 24 h. Coronary angiography was performed at a mean of 3 d after admission. RESULTS: There were no significant differences among the 4 groups in age, sex, coronary risk factors, or multivessel disease. Patients with both admission elevation and increase at 24 h had higher rates of ST-segment depression and positive troponin T at admission. Multivariate analysis showed that admission elevation (odds ratio [OR] 1.50, p < 0.05) and increase at 24 h (OR 6.56, p = 0.03) were independent predictors of 30-d events (e.g., death, myocardial infarction, or refractory angina). The highest risk of 30-d events was associated with both admission elevation and increase at 24 h. CONCLUSIONS: Serial CRP measurements are useful for predicting the risk of subsequent ischemic complications in patients with NSTE-ACS. Copyright (c) 2008 Wiley Periodicals, Inc.     

Changes in serum interleukin-6 and high-sensitivity C-reactive protein levels in patients with acute coronary syndrome and their responses to simvastatin

The role of inflammation in acute coronary syndrome (ACS) and the mechanism by which statin treats ACS is explored. Serum high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) levels were measured in 50 patients with ACS [including 30 cases with unstable angina (UA) and 20 patients with acute myocardial infarction (AMI)], 34 patients with stable angina (SA), and 30 controls. Patients in the ACS group were randomly assigned to a simvastatin group (including a simvastatin AMI subgroup, n = 11 and a simvastatin UA subgroup, n = 14) and a routine group (including a routine AMI subgroup, n = 9 and a routine UA subgroup, n = 16). The simvastatin group was given simvastatin 20mg/day and the routine group a placebo. After a 3-week follow-up, serum hs-CRP, IL-6 levels, and serum lipid concentrations were measured again. Both serum IL-6 and hs-CRP levels were significantly higher in the ACS group (including the UA and AMI subgroups) than in the SA and control groups (P < 0.001). After 3 weeks of treatment with simvastatin, the serum IL-6, hs-CRP, total cholesterol, and low-density lipoprotein cholesterol levels were decreased significantly in the simvastatin group (P < 0.001), but no significant changes were observed in the routine group. No relationship was observed between the rate of decrease of serum IL-6 or hs-CRP and serum lipids levels. The hs-CRP level showed a significant correlation with IL-6 by Spearmans rank correlation analysis (P < 0.01). Inflammation plays an important role in the initiation of ACS. Simvastatin possesses an anti-inflammatory effect, independent of its lipid-lowering action, which may play an important role in the early treatment of ACS.