Introduction
In recent years, with the gradual ageing of the
population and the change of dietary habits in China, the incidence
of cardiovascular disease has increased gradually. Coronary heart
disease has received most attention from medical workers because of
its high fatality rate, especially the acute onset of coronary
heart disease (1,2). Acute coronary syndromes mainly include
ST-segment elevation myocardial infarction (STEMI),
non-ST-elevation myocardial infarction (NSTEMI) and unstable angina
pectoris (UAP).
At present, coronary angiography is regarded as the
gold standard in the diagnosis of coronary heart disease, which has
the disadvantages of high cost and inconvenience. Thus, it is
crucial to conduct the early diagnosis and effective treatment by
combining with enquiry about patients medical history, as well as
physical and laboratory examination (3–5). STLT-1
has a common genetic origin with the triggering receptor expressed
on myeloid cells (TREM), which is a natural immune receptor
activated by associated receptor proteins. Bilirubin is a bile
pigment, which is the main metabolite of iron porphyrin compounds
in vivo. It has antioxidant function and can inhibit the
oxidation of linoleic acid and phospholipids.
In this study, the serum soluble TREM-like
transcript-1 (STLT-1) and bilirubin levels in each group of
patients were determined, so as to estimate the early diagnosis and
prognosis.
Patients and methods
General data
A total of 125 patients of acute coronary syndrome
and 48 cases with normal coronary angiography admitted to People's
Hospital of Rizhao (Rizhao, China) from January 2015 to September
2016 were selected, and all of them met the standards in the
guidelines of the American College of Cardiology and the American
Heart Association for coronary syndromes in 2012 (6). There were 45 cases with STEMI, 36 cases
with NSTEMI and 44 cases with UAP. The selected patients had no
severe acute or chronic infection, organ dysfunction or malignancy.
The statistical analysis revealed that there were no significant
differences in age, sex, dietary habit and blood lipid among the
patients admitted to the hospital (Table
I), indicating that the data were comparable. The study was
approved by the medical Ethics Committee of People's Hospital of
Rizhao, and the patients or their families signed informed
consent.
 | Table I.Comparison of general data among the
four groups. |
Table I.
Comparison of general data among the
four groups.
| General data | Group STEMI | Group NSTEMI | Group UAP | Group normal
control | χ2/t | P-value |
|---|
| Total | 45 | 36 | 44 | 48 |
|
|
| Sex (%) |
|
|
|
|
|
|
| Male | 25 | 19 | 21 | 24 | 3.06 | 0.36 |
|
Female | 20 | 17 | 23 | 24 | 3.06 | 0.36 |
| Age (years) | 57±3.24 | 54±3.09 | 52±3.11 | 52±3.09 | 1.23 | 0.29 |
|
|
|
|
|
|
| 0.38 |
| Cholesterol
(mmol/l) | 6.12±1.2 | 6.02±1.1 | 5.89±1.2 | 5.99±1.2 | 1.11 | 0.59 |
Methods
Venous blood (3 ml) was collected using vacuum
anticoagulation blood collection tube from the patients on
admission. Patients in STEMI, NSTEMI and UAP groups were treated
with aspirin (Bayer AG, Leverkusen, Germany) at a dose of 100 mg Qd
and clopidogrel (Sanofi S.A., Paris, France) at a dose of 75 mg Qd.
Fasting blood was extracted from each patient on the 3rd, 7th and
10th day after treatment. Serum levels of STLT-1 were determined
using ELISA kit (Oumeng, Biotechnology Co. Ltd., Beijing, China).
An ADVIA1800 automatic biochemical analyzer was used to determine
serum bilirubin levels (Siemens, Berlin, Germany). The patients
were followed up by telephone for a year at regular intervals after
discharge. The prognosis of the patients was analyzed.
Statistical analysis
Statistical Product and Service Solutions (SPSS)
17.0 software (SPSS, Inc., Chicago, IL, USA) was used for
statistical analysis. Measurement data are expressed as mean ±
standard deviation. The analysis of variance was adopted for
comparison among the groups and the post hoc test used was Dunnett
test, and t-test was utilized for comparison between the groups.
The Chi-square test was used for enumeration data. P<0.05 was
set as the test level.
Results
Comparison of serum levels of STLT-1
before and after treatment in each group of patients
At admission, there were no statistically
significant differences in serum STLT-1 among the groups
(P>0.05). Compared with the normal control group, the serum
levels of serum STLT-1 in groups STEMI, NSTEMI and UAP were higher,
and the differences were statistically significant (P<0.05).
Moreover, the serum STLT levels in groups STEMI and NSTEMI were
higher than those in group UAP, and the differences were
statistically significant (P<0.05). There was no statistically
significant difference in comparison with serum STLT-1 level
between groups STEMI and NSTEMI (P>0.05). With the prolongation
of treatment time, STLT-1 level in groups STEMI, NSTEMI and UAP was
decreased (P<0.05), and the value at each time point was
different from that at the previous point, which was statistically
significant (Table II).
| Table II.Comparison of serum levels of STLT-1
between and after treatment in each group of patients (pg/ml). |
Table II.
Comparison of serum levels of STLT-1
between and after treatment in each group of patients (pg/ml).
|
|
| STLT-1 |
|
|
|---|
|
|
|
|
|
|
|---|
| Groups | Cases (no.) | At admission | 3rd day after
treatment | 7th day after
treatment | 10th day after
treatment | F | P-value |
|---|
| STEMI | 45 | 541.2±132.7 |
503.7±122.5a–c |
361.2±103.1a–c |
225.9±73.2a–c | 8.05 | <0.05 |
| NSTEMI | 36 | 527.6±140.1 |
505.1±117.7abc |
322.5±98.2abc |
213.1±76.1a,c | 8.16 | <0.05 |
| UAP | 44 | 518.7±126.2 |
469.2±132.7a,c |
276.3±85.1a,c |
156.2±55.4a,c | 8.22 | <0.05 |
| Normal control | 48 | 498.3±119.4 |
254.2±85.3c |
112.4±41.5c |
85.1±33.8c | 8.21 | <0.05 |
| F |
| 1.23 | 8.46 | 8.25 | 8.66 |
| P-value |
| >0.05 | <0.05 | <0.05 | <0.05 |
Comparison of serum levels of
bilirubin before and after treatment in each group of patients
At admission, there were no statistically
significant differences in serum bilirubin among the groups
(P>0.05). Compared with the normal control group, the serum
levels of serum bilirubin in groups STEMI, NSTEMI and UAP were
lower, and the differences were statistically significant
(P<0.05). Moreover, the serum bilirubin levels in groups STEMI
and NSTEMI were lower than those in group UAP, and the differences
were statistically significant (P<0.05). There was no
statistically significant difference in comparison with serum
bilirubin level between groups STEMI and NSTEMI (P>0.05). With
the prolongation of treatment time, bilirubin level in groups
STEMI, NSTEMI and UAP was increased (P<0.05), and the value at
each time point was different from that at the previous point,
which was statistically significant (Table III).
| Table III.Comparison of serum levels of
bilirubin between and after treatment in each group of
patients. |
Table III.
Comparison of serum levels of
bilirubin between and after treatment in each group of
patients.
|
|
| Bilirubin |
|
|
|---|
|
|
|
|
|
|
|---|
| Groups | Cases (no.) | At admission | 3rd day after
treatment | 7th day after
treatment | 10th day after
treatment | F | P-value |
|---|
| STEMI | 45 | 10.21±3.16 |
12.45±3.21abc |
13.68±2.84abc |
15.42±2.54abc | 8.78 | <0.05 |
| NSTEMI | 36 | 10.95±2.69 |
12.89±2.58abc |
14.31±2.73abc |
15.67±2.21abc | 8.84 | <0.05 |
| UAP | 44 | 13.48±3.09 |
14.53±2.42a,c |
15.24±2.42a,c |
15.89±2.16a,c | 9.02 | <0.05 |
| Normal control | 48 | 16.57±1.96 |
16.79±1.89c |
16.63±1.92c |
16.72±1.95c | 9.21 | <0.05 |
| F |
| 1.23 | 8.46 | 8.25 | 8.66 |
|
|
| P-value |
| >0.05 | <0.05 | <0.05 | <0.05 |
|
|
Complications in the three groups of
patients with acute coronary syndrome
The comparison in prognosis of the patients in the
later stage revealed that the proportions in the occurrence of
myocardial infarction, intractable angina pectoris and deep vein
thrombosis (DVT) were significantly increased in groups STEMI and
NSTEMI compared with those in group UAP, and the differences were
statistically significant (Table
IV).
| Table IV.Comparison of complications in the
three groups of patients with acute coronary syndrome [n (%)]. |
Table IV.
Comparison of complications in the
three groups of patients with acute coronary syndrome [n (%)].
| Groups | Cases (no.) | Myocardial
infarction | Intractable angina
pectoris | Deep vein
thrombosis | Cardiac death |
|---|
| STEMI | 45 | 6
(13.3%)a | 9
(20%)a | 4
(8.9%)a | 2 (4.4%) |
| NSTEMI | 36 | 5
(13.8%)a | 8
(22.2%)a | 4
(11.1%)a | 2 (5.6%) |
| UAP | 44 | 3 (6.8%) | 13 (29.5%) | 2 (4.5%) | 1 (2.3%) |
| χ2 |
|
3.23 |
2.39 |
2.67 |
2.45 |
| P-value |
| <0.05 | <0.05 | <0.05 | <0.05 |
Discussion
Coronary heart disease derives from coronary
atherosclerosis caused by various risk factors, thus, leading to
stenosis or obstruction of the blood vessels, further inducing
myocardial hypoxia, or even infarction (7). In recent years, with the process of
aging and dietary changes, the incidence of coronary heart disease
in China is on the rise. If acute coronary syndrome fails to be
diagnosed in time and treated effectively, it will bring great
burden to the family and society due to its extremely high
mortality rate (8). Therefore, the
early diagnosis and treatment of coronary syndrome and the
reduction of certain risk indicators are of great importance to
rescue the endangered myocardium and ameliorate the prognosis of
patients with acute coronary syndrome.
STLT-1 is a protein produced by the cleavage of
TLT-1 on the surface of platelets. When the body has an
inflammatory response due to various reasons, the level of STLT-1
in the serum may increase significantly (9,10).
Related studies indicate that STLT-1 has a promoting role in
coronary heart disease. It plays a regulatory role in platelets,
leukocytes and endothelial cells, which mainly adhere to vascular
endothelial cells by promoting actin polymerization, thus inducing
the occurrence of atherosclerosis and promoting the development of
coronary heart disease (11,12). The study by Esponda et al
(13) indicates that STLT-1 is
remarkably elevated in the serum of patients with acute coronary
syndromes. The present study also confirmed that serum level of
STLT-1 in patients with acute coronary syndromes was higher than
that in controls, which was consistent with the above findings. The
present study demonstrated that the serum levels of STLT-1 in
groups STEMI and NSTEMI were higher than those in group UAP, and
the proportions of complications in groups STEMI and NSTEMI were
significantly higher than those in group UAP. In recent years, the
study of bilirubin has indicated that it plays an important role in
cardiovascular and cerebrovascular diseases. Bilirubin is a
powerful antioxidant in the body, and different types of bilirubin
are effective antioxidants that can scavenge oxygen free radicals
from the body and protect low-density lipoproteins in the body, in
order to resist the damage to the blood vessel and reduce the
possibility of atherosclerosis (14,15).
Studies worldwide have shown that the level of bilirubin in serum
is negatively-related to the incidence of coronary heart disease
(16,17). This study revealed that the serum
bilirubin levels in groups STEMI, NSTEMI and UAP were lower than
those in the normal control group, and the serum bilirubin levels
in groups STEMI and NSTEMI were lower than those in group UAP.
The present study indicated that the serum level of
STLT-1 was elevated with the increase of severity of acute coronary
syndrome, which could gradually decrease through the effective
treatment, and patients with lower STLT-1 level in the group UAP
had a relatively low proportion of severe complications. The
bilirubin level was lower in group STEMI than that in the normal
control and UAP groups, which could be gradually enhanced after
treatment, and patients with higher bilirubin level in the group
UAP had a relatively low proportion of severe complications. In
terms of prognosis, patients with STEMI and NSTEMI were more severe
than patients with UAP. Myocardial cell damage was observed in
STEMI and NSTEMI groups. It is speculated that the prognosis of
STEMI and NSTEMI is worse than that of UAP. Levels of STLT-1 and
bilirubin in STEMI and NSTEMI groups were also higher than those in
UAP. However, further studies are needed to investigate the
mechanism.
Therefore, we believe that the timely and effective
treatment administered to patients with acute coronary syndrome
during the initial stage to reduce the level of STLT-1 in serum and
enhance bilirubin to a relatively high level is conducive in
ameliorating the prognosis of patients, which has an important
clinical significance.
Acknowledgements
Not applicable.
Funding
No funding was received.
Availability of data and materials
The datasets used and/or analyzed during the current
study are available from the corresponding author on reasonable
request.
Authors contributions
RF wrote the manuscript. RF and XS were responsible
for collecting the clinical and laboratory information. DS and SL
analyzed venous blood. LG and CJ contributed to follow-up and
statistical analysis. All authors read and approved the final
manuscript.
Ethics approval and consent to
participate
The study was approved by the medical Ethics
Committee of People's Hospital of Rizhao (Rizhao, China) and the
patients or their families signed the informed consent.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing
interests.
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