Biomarkeri inflamacije u ishemijskoj bolesti srca
Biomarkers Of Inflammation In Ischemic Heart Disease
UniversityУниверзитет у Крагујевцу
FacultyУниверзитет у Крагујевцу, Факултет медицинских наука
Background: Ishemic heart disease is mostly a consequence of atherosclerosis. Atherosclerosis, a chronic inflammatory disease, underlies the pathogenesis of coronary artery disease. The present study assessed the diagnostic and prognostic validity of inflammatory biomarkers, including high sensitive C-reactive protein (hsCRP),fibrinogen, ESR, leukocytes, serum neopterin, nitrite/nitrate (NO2 –/NO3–), inducible nitricoxide synthase (iNOS), tumor necrosis factor-α (TNF-α) and asymmetric dimethylarginine (ADMA) and their correlation with risk factors in patients with acute coronary syndrome and stable angina pectoris. Methods: We studied 74 patients with chronic stable angina pectoris, 73 with unstable angina, 94 with acute myocardial infarction and 66 age-matched healthy volunteers (control group). Serum neopterin, ADMA, iNOS and TNF-α were determined by the commercially available enzyme linked immunosorbent assay methods and NO2 – /NO3– by the modified cadmium-reduction method. The diagnostic accuracy of markers was evaluated by the ROC curve analysis. Results: Mean serum neopterin levels were significantly higher in patients with unstable and stable angina pectoris in comparison to control subjects (p<0.05, for both patients groups). Serum NO2-/NO3– values were significantly elevated (p<0.01) in patients with unstable angina and acute myocardial infarction. Serum iNOS were significantly elevated in patients with unstable angina pectoris in comparison to control subjects (p<0.05). TNF- α was significantly elevated in patients with acute myocardial infarction in comparison to patients with stable angina pectoris (p<0.001) and the control group (p<0.01). Serum ADMA values were significantly elevated (p<0.001) in all patient groups. The highest concentration of hsCRP, fibrinogen and leukocytes were noted in patients with acute myocardial infarction, while ESR was significantly higher in patients with unstable angina pectoris. A strong correlation was found between LE and smoking (p<0.05), and triglycerides and ESR (p<0.05), neopterin and physically inactivity (p<0.05), NO2–/NO3–and both DM (p<0.01) and physically inactivity (p<0.05) in stable angina pectoris patients. In unstable angina pectoris patients a significant correlation was found between smoking and hsCRP (p<0.05), familly history and both fibrinogen (p<0.05) and LE (p<0.05), neopterin and concentration of lipids (p<0.05), obesity and NO2 –/NO3– (p<0.05). Also significant correlation was found between DM and both LE (p<0.05) and hsCRP (p<0.01), ADMA and both DM (p<0.05) and smoking (p<0.05) in patients with acute myocardial infarction. Conclusion: The results of this study suggest that elevated baseline levels of ADMA are a strong and independent predictor of ischemic heart disease. Continuous monitoring of serum neopterin and NO2–/NO3– levels may indicate future plaque instability. Interdependence between inflammatory markers and cardiovascular risk factors was established.