The Comparison of Acute Myocardial Infarction Serum Anticardiolipin Antibody with Healthy Subjects, in Gorgan (Northern Iran)
Ali Reza Ahmadi,
Hamid Reza Joshaghani,
Azad Reza Mansourian,
Arthrosclerosis considered one of the most important causes of morbidity and mortality in industrial and developing countries. The rate of myocardial infarction in some countries is about 2 million annually with 1/4 of them is leading to death. This study was a case-control research, which was carried out as cross-sectional project in two groups, healthy and case subjects. The mean age and standard deviation of patients and control groups were nearly equal (55±10). The ELISA technique was applied to measure the serum antibody level. The sample populations in each group were exactly the same (120 person in each group). The gender distribution in case and control group was 44 female, 76 male and 45 female and 75 male, respectively. The Mean±SD of IgM in case group and control groups were 3.10± 2.54 and 1.54±1.00, respectively. The Mean±SD for IgG in case and control groups were 5.90±3.84 and 3.08±1.95, respectively. The differences, between the mean of IgM and IgG in two groups of cases and control statistically were significant (p = 0.0001). In case group the Mean±SD for IgM for men and woman were 2.98±1.97 and 3.17±2.83, respectively, which this differences statistically, were not significant. In case group the Mean±SD for IgG were 5.14±3.45 and 6.35. The above findings indicated that the average of both IgG and IgM are higher among men compared to women. Due to high prevalence of acute coronary syndrome in Iran, the determination of anticardiolipin antibody (IgG) are applied for suspected acute coronary syndrome patients and further prevention measure should be taken for patient with higher serum anticardiolipin antibody.
to cite this article:
Ali Reza Ahmadi, Hamid Reza Joshaghani, Azad Reza Mansourian, Aref Salehi and Nasser Behnampour, 2013. The Comparison of Acute Myocardial Infarction Serum Anticardiolipin Antibody with Healthy Subjects, in Gorgan (Northern Iran). Pakistan Journal of Biological Sciences, 16: 92-96.
Received: December 26, 2012;
Accepted: March 07, 2013;
Published: March 14, 2013
Arthrosclerosis considered being one of the most important causes of morbidity
and mortality in industrial and developing countries. The rate of myocardial
infarction in U.S. is about 2 million annually with 1/4 of them is leading to
death (Cannon, 2003, El-Sayed et
al., 2007). The prevalence of coronary vascular disease in central Iran
is about 9.3%. It is reported that 38% of all death in Iran are due to heart
diseases. The reasons behind arthrosclerosis are genetically related, acquired
risk factors, such as high blood cholesterol. Due to nutritional habitual; high
blood pressure, obesity, diabetes, cigarettes smoking, low physical activity,
some inflammatory mechanisms can disrupt the regulation of fat within the vain
and initiate the arthrosclerosis lesion (Sherer and Shoenfeld,
2002). The recent studies indicate the role plagued by immunological responses
in induction of arthrosclerosis. These latest response include the chemical
component of CRP, other infectious agents, such as Chlamydia pneumonia
and autoantibodies. The various auto-antibodies genes, which can cause and mediate
the cardiovascular disease, are including cardiolipin, OXLDL, β2GP1 and
HSP (Jara et al., 2006; Su
et al., 2006). Antiphospholipids immunoglobulin is examples of such
autoantibodies. These autoantibodies can be found in healthy subjects as well
but their concentration are low and are found partially is short period of time
with the individual blood circulation. The phospholipid autoantibodies of non-autoimmune
origin are seen in such disorder as HIV and in some cancers (George
et al., 1997; Salehi and Mirzaei, 2007;
Jara et al., 2006).
The majority of phospholipid antibodies are seen in a one autoimmune antibody
named, Antibody Phospholipid Syndrome (APS). The other characteristic of APS
are thromboembolic and pregnancy abortions. The APS considered as mediator of
autoimmunity and arthrosclerosis (George and Shoenfeld,
1997). The antiphospholipids are integrated with various forms of cardiovascular
diseases, such as myocardial infractions. (Sherer and Shoenfeld,
2003; Vaarala et al., 1995). Anti Cardiolipin
Antibody (ACA) is an antibody raised against cardiolipin and in disease such
as APS, autonomous abortion, thrombosis and lupus. Anticardiolipin antibody
can be divided into two categories; 1) class-I: of Immunoglobulin M (IgM). Immunoglobulin
G (IgG), Immunoglobulin A (IgA. 2) Dependent or non-dependent to β-2-glycoprotein.
This test is requested when the signs of a traumatic accident, such as pain,
inflammation in lower organs, respiratory disorder, accompanied with pain are
indicated. It is also advised on repeated pregnancy abortion and lupus. Considering
the high scale of acute coronary heart diseases and in particular acute myocardial
infraction and possible role played by anticardiolipin in acute coronary syndromes
(Erkkila et al., 2005, Levine
and Jacobs, 2001; Sherer and Shoenfeld, 2003, Wu
et al., 1997; Sherer et al., 2001)
and particularly due to the absence of a documented para clinical tests and
reference into the relation between cardiovascular disorders and the blood antibody
level, this present research project was designed to address such queries in
this region of northern Iran.
MATERIALS AND METHODS
Type of research: This study was a case control study which was cross-sectionally carried out in two groups. Due to technical difficulties and the absence of other types of heart diseases, the sample population in the case groups predominantly were from those patients with acute myocardial infarctions.
Method of sampling: On the base of statistical parameter the exact number of patient was calculated to be 116 but for sake of security and avoiding any mistake 120 patients were selected. Etheical procedure was applied in this study and all patients were informed on the study procedure and the patients entered in this on their own choice. All the patients were matched on such variables as, age and gender.
Data collection: A questioner was used fore very patient, clinical examination
and serological measurement was done by cardiologist and clinical laboratory.
The information within the questionnaires, the medical examination files, laboratory
tests, were arranged and entered into SPSS statistical software and presented
as a tables and figures. The statistical Kolmogorov-Simonov test was used to
compare the mean of two antibodies of IgM and IgG.
Statistical analysis: Initially the serum of two antibodies of IgG, IgM should have been compared , therefor the normal range and positive results in this study should have been determined before the actual measurement Kolmogorov-Smirnov test was applied for the determination of normal range in this study. Using this statistical equation the following results was designed.
||>5 GPL mL-1
||>15 MPL mL-1
||≤15 MPL mL-1
||≤15 GPL mL-1
The mean age and standard deviation of patients and control groups were nearly
equal (55±10). The sample population in each group was exactly the same
(120 person in each group). The gender distribution in case and control group
were 44 female, 76 male and 45 female and 75 male, respectively. In this study
The matching among case and control was performed properly according to Table
1 and even the gender matching was also were established to obtain the proper
results. The Mean±SD of Immunoglobulin M (IgM) in case group and control
groups were 3.10±2.54 and 1.54±1.00, respectively. The Mean±SD
for Immunoglobulin G IgG in case and control groups were 5.90±3.84 and
3.08±1.95, respectively. The differences, between the mean of IgM and
IgG in two groups of cases and control statistically were significant (p = 0.0001).
In case group the Mean±SD for IgM for men and woman were 2.98±1.97
and 3.17±2.83 respectively which this differences statistically were
not significant (p = 0.697). In case group the Mean±SD for IgG were 5.14±3.45
and 6.35±4.01, respectively. The above findings indicated that the average
of both IgG and IgM are higher among men compared to women but this difference
statistically was not meaningful (p = 0.095) (Table 2).
|| The matching among case and control in general in one hand
and between two genders of male and females
||Status of antiphospholipids antibodies of immunoglobulin G
(IgG) and Immunoglobulin M (IgM) among male and female in case and control
|| Serum immunoglobulin G (IgG) and immunoglobulin M (IgM) concentration
level among patient and healthy subjects
|Values in brackets are percentage
In this research project the serum IgG and IgM concentration was determined
among case and control groups and the results were tabulated in Table
3 which is shown that there is a statistically significant correlation between
patients and healthy subjects antibodies level.
In control group (Table 2) the Mean±SD of IgM for women and men were 1.67±1.23 and 1.46±0.84, respectively which statistically were not significant (p = 0.266). The Mean±SD for were 3.04±1.95 and 3.06±1.97, which again it was not statistically significant (P+0.917). The comparison of mean of IgM and IgG in both group of case and control among women and men were as follow.
Women: The Mean±SD for IgM is both case and control groups were 2.98±1.97 and 1.67±1.23, these findings statistically were significant (p = 0.0003). TheMean±SD for IgM in both case and control groups were 5.14±3.45 and 3.06±1.97, respectively; this latter difference statistically were significant. (p = 0.0007).
Men: The Mean±SD of IgM in both case and control group were 3.17±2.83
and 1.46±0.83 which statistically were significant (p = 0.00001). The
Mean±SD for IgM in both groups of case and control were 6.35±3.09
and 3.09±1.95, respectively.
Acute myocardial infarction and Unstable Angina (UA) are among wide range of
recognized diseases, collectively known as acute coronary syndrome. The pathophysiology
of this diseases are due to displace, or disruption of atheroma from coronary
internal vascular system. Acute coronary syndromes are among the most common
form of sudden death and it is well established that about 50% of AMI patients
die before reaching to the hospitals. Earlier studies on the serum Anticardiolipin
antibody, level in AMI and its normal range and the relationship of this antibody
with AMI and related morbidity and mortality are found to have contradictory,
results (Brey et al., 2001; George
and Shoenfeld, 1997). Our study indicated that there are a significant different
between the serum cardiolipin antibody of AMI patient compared with the control
group. In our study we found that there is a significant correlation between
the AMI and IgG, IgM serum concentration levels. Also in this study we found
that Patient/Healthy ratio was found to be 13.22 and 14.458, for IgG and IgM,
respectively compared to the subjects which they have normal IgG and IgM serum
concentration levels. Anticardiolipin antibody is considered as a major characteristic
of antiphospholipids syndrome and in the other hand there is a tendency toward
thrombosis onset. It is probable, that anticardiolipin antibody play an important
role in occurrence and intensity of AMI due to vascular abnormality.
In a study the effective role of anticardiolipin antibody and its relationship
with arthrosclerosis in mice it was demonstrated that the mice which were immunized
with anticardiolipin antibody and having the higher, titer of anticardiolipin
antibody and arthrosclerosis intensity were observed among mices compared to
control group (Sherer and Shoenfeld, 2002; George
et al., 1997). In agreement with our study it is demonstrated that
higher anticardiolipin antibody serum concentration is considered as risk factor,
in AMI and in elderly men. (Sherer and Shoenfeld, 2002).
In separate study on 63 patients afflicted with the ACS, which were admitted
to the CCU during 2003-04, the average anticardiolipin antibody among patient
were 4.35±2.7 and in the control group it was 3.38±3.1 which demonstrated
to have significant differences (p = 0.038). This average for men in case and
control group were 4.47±2.22 and 3.08±2.17, respectively which
statistically were significant (p = 0.002).
In latter study, there was not a meaningful difference among female in case and control group, 4.1±3.58 vs. 3.69± 3.89 (p = 0.634). The latter finding are in agreement with our general population average and also men average but our finding about women is contradicted other results, because, in our study we found an significant difference among women in case and control group (p = 0.0007). In our study we found also a statistically significant correlation of higher level of IgG and IgM levels among AMI patients which is an interesting finding which can be used in laboratory investigation for AMI patient clinical setting. Also we should mention that in our study we found that there is not meaningful correlation between IgG and IgM levels and AMI among women but there is a meaningful correlation between IgG and IgM serum level and AMI among men, which is an interesting finding .
This disagreement can be explained as follow, in Salehi
and Mirzaei (2007) study the sample population of case and control were
not equal 63 vs. 103. The other explanation is that, in our study in spite of
extra clinical and Para clinical examination such as ANA test, we were not able
to discriminate the coexistence of other disease such as lupus but we are in
opinion that the former possibility can fit these differences. One further clue
to this disagreement may be relay on the differences on the women mean age in
case and control group. In other study by Ghaemian et al it was demonstrated
that there was a statistically significant differences between serum anticardiolipin
antibody among patient with AMI and control group (p = 0.01) It was found that
there was, a significant increase of serum anticardiolipin antibody of AMI patient
with control group (37.14±30.18 vs. 13.14±3.02) and based on their
findings it was concluded that anticardiolipin antibody serum level can be considered
as a risk factor for ischemic heart diseases and it is suggested it can be considered
as marker for the subsequent syndrome vascular thrombolytic lesion (El-Sayed
et al., 2007). The latter findings are in agreements with our data
from this study, which indicated that the AMI patients have high anticardiolipin
antibody serum level, compared with control group but it should mentioned that
we measured IgM was measured in addition to IgG which was determined by Elsheikh
et al. (2010).
Based on our finding we can indicate that the mean serum level of IgM and IgG were 4.55-0.55 and 9.9- 1.15 respectively. The sensitivity and specificity for this spectrum of reference rang was calculated as 90%. It is concluded that due to high prevalence of acute coronary syndrome in Iran particularly among men the determination of anticardiolipin antibody (IgG, IgM) are to be applied for the suspected acute coronary syndrome patients and further prevention measure should be taken for the patients with higher serum anticardiolipin antibody.
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