Objective: To explore the relationship between the levels of serum soluble CD137 (sCD137) and membrane-bound CD137 (mCD137) and the occurrence of
ischemia reperfusion injury (IRI) in patients with acute
ST-segment elevation myocardial infarction (
STEMI). Methods: This is a cross-sectional study. Consecutive patients with acute
STEMI, who underwent emergency
percutaneous coronary intervention (PCI) in the Department of Cardiology, Jiangsu University Affiliated Hospital from May 2019 to September 2020, were enrolled. According to the absence or presence of IRI, patients were divided into IRI group and non-IRI group. Clinical data of the two groups were collected and compared. sCD137 level was detected by
enzyme linked
immunosorbent assay.
Ficoll density gradient centrifugation was used to separate peripheral blood mononuclear cells (PBMC) and
RNA was extracted, mCD137
mRNA expression level was detected by PCR. Serum sCD137 levels and the mCD137
mRNA levels of PBMC before, after PCI and 24 hours after PCI were compared. The correlation between serum sCD137 level, PBMC mCD137
mRNA level and clinical indicators was observed. The univariate and multivariate logistic binary regression analyses were performed to evaluate the related risk factors of IRI. ROC curve was used to analyze the predictive value of defined parameters for IRI. Results: A total of 112
STEMI patients were enrolled. There were 42 cases (of which 33 were males (78.6%), mean age was (58.6±12.7) years) in non-IRI group and 70 cases(of which 56 were males (80.0%), mean age was (64.5±11.6) years) in IRI group. Compared with the non-IRI group, patients in the IRI group had longer
hospital stays, older age, lower rates of
obesity, lower systolic and diastolic blood pressure at admission, higher proportion of the the right coronary artery as culprit vessel, lower rate of the use of
angiotensin-converting enzyme inhibitor/
angiotensin-Ⅱ
receptor blocker/angiotensin receptor
neprilysin inhibitor, higher levels of
urea nitrogen and
creatinine, lower glomerular filtration rate, lower
triglycerides, higher
D-dimer and B-type natriuretic peptidemax, higher proportion of Killip grade Ⅳ and cardiovascular adverse events (all P<0.05). sCD137 levels at the preoperative, postoperative and 24 hours after surgery were significantly higher in the IRI group than in the non-IRI group, while the
mRNA levels of CD137 was similar between the two groups. The level of sCD137 in patients after PCI was lower than that before operation, the level of mCD137
mRNA was higher than that before operation (P<0.05). Serum sCD137 levels were positively correlated with hospitalization days, age,
B-type natriuretic peptide,
creatinine, ischemic time,
C Reactive protein (CRP) and CRP/
albumin (P<0.05), and negatively correlated with body mass index, glomerular filtration rate and
albumin (P<0.05). The mCD137
mRNA expression level of PBMC was positively correlated with
hospital stay, age,
B-type natriuretic peptide, ischemic time, CRP and CRP/
albumin (P<0.05), and negatively correlated with body mass index, glomerular filtration rate,
albumin (P<0.05). Multivariate logistic regression analysis showed that higher sCD137 (OR=1.038, 95%CI: 1.009-1.069),
aspartate aminotransferase, (OR=1.029, 95%CI: 1.009-1.050) and lower
albumin (OR=0.829, 95%CI: 0.703-0.829) before surgery were independent risk factors of IRI (P<0.05). Receiver operating characteristic curve showed that the area under the curve of sCD137 was 0.672 (95%CI: 0.574-0.770, P=0.002) for the prediction of IRI, the best cut-off value was 28.43×10-3 μg/L with sensitivity of 95.2% and specificity of 48.6%. Conclusion: The significantly increased level of sCD137 in acute
STEMI patients is positively correlated with
reperfusion injury, which is an independent risk factor of IRI and may be related to the prognosis of patients with IRI.