Combined use of matrix metalloproteinase-9 and N-terminal pro-brain natriuretic peptide in risk stratification of non-ST elevation acute coronary syndrome / 西安交通大学学报(医学版)

Objective To explore the role and relationship of N-terminal pro-brain natriuretic peptide (NT-proBNP) and matrix metalloproteinase-9 (MMP-9 ) in risk stratification and prognosis assessment of non-ST elevation acute coronary syndrome (NSTE-ACS).Methods We recruited 114 patients with NSTE-ACS and classified them into three groups according to the GRACE risk stratification:high-risk,intermediate-risk and low-risk groups.Another 5 8 patients were recruited as controls.Arterial blood was collected before angiography for the measurement of serum NT-proBNP and MMP-9 .Gensini score was used to evaluate the degree of coronary artery stenosis.All the patients were followed up for 6 months and MACE was observed and recorded.Results ① The levels of lg NT-proBNP and MMP-9 significantly differed between the groups (P<0.05).② ROC curve analysis showed that lg NT-proBNP could predict MACE of NSTE-ACS;area under the curve was 0.795,the cutoff value was 2 .0 6 9 ,corresponding to the NT-proBNP value of 1 1 6 .5 6 ng/L.MMP-9 could predict MACE of NSTE-ACS;area under the curve was 0 .6 9 6 ,the cutoff value was 3 2 .4 9 ng/ml;both of the abnormal indexes could predict MACE with the sensitivity of 80.41%,specificity of 82.19%,and Youden’s index of 0.63.③ Cox regression analysis showed that abnormal MMP-9 and NT-proBNP levels were independently related to the incidence of MACE by the value of OR as 3.751.Conclusion MMP-9 and NT-proBNP may be used as serological indicators in risk stratification of NSTE-ACS. The combined use of NT-proBNP and MMP-9 increases the power of predicting MACE.

Relationship of plasma levels of microRNA 491-5p and its target gene polymorphism with the prognosis of patients with premature coronary artery disease / 西安交通大学学报(医学版)

Objective To study the relationship of the plasma levels of miRNA-491-5p in Han population in Shaanxi Province and the changes of single nucleotide polymorphisms (SNP ) of the target gene matrix metalloproteinases-9 (MMP-9 ) of miRNA-4 9 1-5 p (has-miR-4 9 1-5 p ) with the incidence risk and prognosis of premature coronary artery disease (pCAD)through the case-control design.Methods In this study,we made a consecutive recruitment of 270 pCAD cases in the case group and 300 cases in the control group.Using the polymorphism method of polymerase chain reaction and restriction fragment length (PCR-RFLP),target gene MMP-9 of has-miR-491-5p and rs1056628 genotypes was detected to compare the association between the variant genotypes and pCAD.Results In the changes of rs1056628C-A polymorphisms,compared with that of CC genotypes (the incidence was 42%),the risks of having coronary heart disease in the individuals carrying CA and AA genotypes were 31%,the difference was statistically significant (P=0.045).The risks of developing coronary heart disease in the individuals carrying CA and AA genotypes were reduced more significantly in the population with low total cholesterol (TC),and low low-density lipoprotein cholesterol (LDL-C).Conclusion Target gene MMP-9 of has-miRNA-491-5p rs1056628C-A polymorphism is associated with the reduced incidence risk of pCAD,and carrying C alleles is an independent risk factor for pCAD.

The clinical significance of sCD40L and Lp-PLA2 in the assessment of coronary artery severity and risk classification in patients with non-ST-segment elevation acute coronary syndrome / 西安交通大学学报(医学版)

Objective To investigate the clinical significance of soluble CD40 ligand (sCD40L ) and lipoprotein associated phospholipase A2 (Lp-PLA2 ) in the assessment of coronary artery severity and risk classification in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).Methods Of the 9 6 patients with coronary heart disease diagnosed by coronary angiography,2 8 patients had stable angina pectoris (SAP),38 patients unstable angina pectoris (UAP)and 30 patients acute non-ST-segment elevation myocardial infarction (NSTEMI).Another 30 patients with non-coronary heart disease (NC)served as controls.The sCD40L and Lp-PLA2 levels were determined by enzyme-linked immune sorbent assay (ELISA)method.The Gensini score was used to assess the severity of coronary artery and analyze the correlation with sCD40L and Lp-PLA2.The correlation of sCD40L and Lp-PLA2 with GRACE risk score was analyzed too.Results ① sCD40L was significantly higher in NSTEMI and UAP groups than in SAP and NC groups (P0 .0 5 )or SAP and NC groups (P>0 .0 5 ).Lp-PLA2 was significantly higher in NSTEMI group than in UAP,SAP and NC groups (P<0.05).Lp-PLA2 was significantly higher in UAP group than in SAP and NC groups (P<0.05).② We found that sCD40L had obvious correlation with Lp-PLA2 (r=0.284, P<0.01),Gensini score (r=0.213,P<0.05),and GRACE (r=0.224,P<0.05).Lp-PLA2 was significantly correlated with Gensini score (r=0.270,P<0.05),and GRACE (r=0.323,P<0.01).③ Multivariate logistic regression analysis showed that Lp-PLA2 was independently associated with NSTE-ACS (P<0.05).Conclusion The sCD40L and Lp-PLA2 which were significantly elevated in NSTE-ACS are correlated with the severity of coronary artery disease.The two indexes indicate the instability of atherosclerotic plaque;thus they can be used as predictors of risk assessment in coronary heart disease.

Relationship of CD31+/CD42b- and CD144+ endothelial micropaticles with intima-media thickness of carotid artery / 西安交通大学学报(医学版)

Objective To detect the levels of CD31+/CD42b- and CD144+ endothelial microparticles (EMPs)in plasma,and analyze the relationship with carotid intima-media thickness (CIMT)and the risk factors of atherosclerosis.Methods Totally 122 outpatients and inpatients in our hospital were selected,and carotid artery ultrasound examination was performed.The results were divided into a thickening group (62 cases)and a control group (60 cases).Flow cytometry was used to detect the levels of CD31+/CD42b- and CD144+ EMPs in the blood to analyze the relationship between the level of endothelial cells and CIMT,and to investigate the relationship between the level of plasma EMPs and the risk factors of atherosclerosis.Results Compared with the control group,the levels of EMPs of CD31+/CD42b- and CD144+ were significantly higher.In the correlation analysis, plasma CD31+/CD42b- and CD144+EMPs levels were positively correlated with CIMT;in multi-factor Logistic regression analysis,CD31+/CD42b- EMPs levels were correlated positively with age,TC and Cys C;plasma CD144+ EMPs levels were correlated with UA and BMI.Conclusion The levels of CD31+/CD42b-,CD144+EMPs in plasma were correlated with CIMT,guiding early prevention of cardiovascular diseases.

Research of candesartan combined with levamlodipine besylate on target organ protection in patients with hypertension / 中国医师进修杂志

Objective To explore the effect of candesartan combined with levamlodipine besylate on hypertension and target organ protection.Methods One hundred and twenty-two patients with hypertension and proteinuria from February 2011 to July 2013 were divided into observation group (61 cases) and control group (61 cases) by random number table method.Patients in both groups were given oral candesartan 8 mg/d,and the observation group was treated with levamlodipine besylate 2.5 mg/d on this basis.Six months after treatment,the blood pressure levels,carotid intima-media thickness (IMT),interventricular septum thickness (IVST),left ventricular posterior wall thickness (LVPWT),left ventricular end diastolic diameter (LVEDD),left ventricular mass index (LVMI) and renal function between 2 groups were observed.Results After 6 months of treatment,the total effective rate in observation group was 86.9％ (53/61),and in control group was 72.1％ (44/61),there was significant difference (P ＜ 0.05).Systolic blood pressure and diastolic blood pressure levels in two groups after treatment were decreased,in observation group which were lower than those in control group,and there was significant difference (P ＜ 0.05).IVST,LVEDD,LVPWT,LVMI and carotid IMT in 2 groups after treatment was lower than that before treatment,in observation group which was obviously lower than that in control group [(8.5 ± 1.3) mm vs.(9.2 ± 1.2) mm,(39.6 ± 4.8)mm vs.(44.3 ± 3.9) mm,(8.4 ± 1.4) mm vs.(9.1 ± 1.3) mm,(89.4 ± 9.3) g/m2 vs.(97.3 ± 8.9) g/m2,(8.3 ± 0.3) mm vs.(8.7 ± 0.5) mm],and there were significant differences (P ＜ 0.05).Urea nitrogen between 2 groups before and after treatment had no significant difference(P ＞ 0.05).The serum creatinine,creatinine clearance rate,total 24 h urinary albumin and microalbuminuria in 2 groups was significandy improved compared with that before treatment,and in observation group after treatment was obviously improved compared with that in control group [(94.6 ±25.5) μmol/L vs.(118.5 ±38.4) μmol/L,(102 ±24) ml/min vs.(96 ± 18) ml/min,(1.05 ± 0.51) mg/24 h vs.(1.27 ± 0.22) mg/24 h,(155 ± 36) mg/L vs.(185 ± 41) mg/L],there were significant differences (P ＜ 0.05).Conclusions The effect of candesartan combined with levamlodipine besylate in treatment of hypertension and proteinuria is better than monotherapy.Combination therapy in reversing left ventricular,improving carotid IMT,protecting kidney function and reducing proteinuria has significant effect,and has no obvious adverse reactions.It is worthy of clinical application.