Objective To observe the effects of salvianolate injection on blood levels of high sensitively C-reactive protein (hs-CRP),pregnancy associated plasma protein-A (PAPP-A) and brain natriuretic peptide (BNP) in elderly patients with acute myocardial infarction.Methods The elderly patients with AMI (AMI group,n=160) and healthy controls (control group.n=30) were enrolled in this study and their blood concentrations of PAPP A,hs CRP and BNP were detected before and two weeks after treatment.The elderly patients in AMI group were randomized into conventional treatment group (n =80) and salvianolate group (n =80).Results The levels of PAPP-A,hs-CRP and BNP were significantly higher in AMI patients [(12.88±2.56) mg/L,(20.13 ±5.35) mU/L,(412.0±69.5) ng/L,respectively] than in healthy subjects[(1.20±0.88) mg/L,(1.90±0.46) mU/L,(89.0±5.6) ng/L,respectively] (t=24.670,3.780,11.939,respectively,P ＜0.01).But,before treatment there were no significant differences in the levels of PAPP-A,hs-CRP and BNP between the AMI group and control group (t=0.864,0.712,0.985,all P＞0.05).After two weeks of treatment,as compared with control group,AMI group showed that the serum concentrations of PAPP-A,hs-CRP and BNP were decreased significantly (P＜0.05).The levels of PAPP A,hs-CRP and BNP were (3.83±1.20) mg/L,(1.33±0.38) mU/L,(105.0±31.2) ng/L in salvianolate group and (5.71± 1.93) mg/L,(1.81±0.72) mU/L,(150.0±36.7) ng/L in conventional treatment group respectively,and the decrements in levels of PAPP-A,hs CRP and BNP were greater in the former than in the latter(t=7.399,5.273,8.356,respectively,all P＜0.05).Conclusions The dynamic serum concentrations of PAPP-A,hs CRP and BNP can be used as clinical indexes for the prognosis of acute myocardial infarction.Salvianolate injection can significantly decrease the serum levels of PAPP A,hs CRP and BNP.The salvianolate injection may have anti inflammatory effect and improve cardiac function in elderly patients with acute myocardial infarction,but the mechanism is still to be further discussed.

BACKGROUNDThoracic endovascular aortic repair (TEVAR) is an emerging treatment modality, which has been rapidly embraced by clinicians treating thoracic aortic disease. However, the clinical manifestations of systemic inflammatory response after TEVAR as post-implantation syndrome (PIS) resemble the perioperative infection. This study aimed to evaluate changes and diagnostic value of procalcitonin (PCT) and other traditional inflammatory markers for infections after TEVAR.

METHODSWe conducted a prospective clinical study that enrolled 162 consecutive aortic dissection cases, who underwent TEVAR in our institution between July 2011 and November 2012. The PCT, C-response protein (CRP), erythrocyte sedimentation rate (ESR) and blood routine examination were monitored before the operation and on days 1, 2, 3 and 5 after the operation. The diagnosis of infection was confirmed by the infection control committee with reference to Hospital Acquired Infection Diagnostic Criteria Assessment, released by the Ministry of Health of the People's Republic of China.

RESULTSPost endovascular repair of thoracic aorta, PCT changes significantly at different time points (χ(2) = 13.225, P = 0.021), without significant difference between the PIS group and the control group (0.24 ± 0.04 vs.0.26 ± 0.10, P = 0.804). PCT values were significantly higher in the first day after TEVAR than the preoperative levels (0.18 ± 0.03 vs. 0.11 ± 0.02, P < 0.001). Compared with PIS patients, the level of PCT, CRP, White blood cell (WBC) and neutrophil (NEU) in the infection patients elevated significantly (relatively χ(2) = 6.062, P = 0.048; χ(2) = 6.081, P = 0.048; χ(2) = 11.030, P = 0.004; χ(2) = 14.632, P = 0.001). According to the ROC analysis, the PCT levels in the first day after TEVAR (AUC = 0.785, P = 0.012) had better predictive values of infection than WBC, NEU CRP and ESR (AUC = 0.720, P = 0.040; AUC = 0.715, P = 0.045; AUC = 0.663, P = 0.274; AUC = 0.502, P = 0.991). The best predictive index was the changes of PCT between preoperative and postoperative (PCT), which possess AUC as 0.803 (P = 0.014). And PCT = 0.055 could be considered as an infection diagnosis cutoff value with a sensitivity of 83.3% and specificity 69.0%.

CONCLUSIONSPCT provides better diagnostic value of infection compared with other inflammatory markers. The potential applications of PCT in differential diagnosis of PIS and infection after percutaneous TEVAR deserve further studies.

Adult ; Aged ; Blood Sedimentation ; C-Reactive Protein ; metabolism ; Calcitonin ; metabolism ; Calcitonin Gene-Related Peptide ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Protein Precursors ; metabolism ; Vascular Surgical Procedures

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