| Unstable angina pectoris(UAP) which can be reversed into stable angina pectoris(SAP) or developed into acute myocardial infarction(AMI)----even sudden death, is an intermediate syndrome between SAP and AMI. It's basic pathology foundation is the unstability of atheromatous plaque in coronary artery, Such as, plaque bleeding; the surface of fibre hat appearing cranny, ulcer; the platelet aggregation that can lead to the narrow lumen or the spasm of coronary stimulated by all kinds of elements that can cause declining of part myocardium blood stream, thus to cause angina. Recently it has become one of the most serious angiocardiopathy. Some research indicates that atherosclerosis (AS) is not a continuous linear process, but a process transformed between stable and instable condition. Usually the attacking of sudden and unpredictable angina is related with the plaque rupture. The damageable plaque is usually unstable plaque. It is common to see that the damageable plaque has thin fibre hat, large fatty atomic, low density of smooth muscle cell, and usually contains macrophage, tissue factor, the cholesterol crystal including polyunsaturated fatty acid of high concentration. The current research shows that human atherosclerotic plaque contains large amount of uric acid. It also can help the expression of MCP-1 by the experiments in vitro; at the same time, increased uric acid levels also can promote oxygenation of low density lipoprotein cholesterol and facilitate lipid perioxidation.These results tell us that serum uric acid may raise the unstability of coronary arterial atheromatous plaque. But we are still not clear about the relationship between serum uric acid and coronary arterial atheromatous plaque till now. Therefore, the author surveyed and evaluated the serum uric acid of patients with UAP and patients with SAP; calculated the Gensini's score of each group by the results of coronary arteriography, then use this to present the severity of coronary artery disease, all the above researches aim to further inquire whether uric acid is the elements that can promote the unstability of coronary arterial atheromatous plaque , which can provide new thoughts for the diagnosis, treatment and prognosis of patients with unstable angina pectoris.This research contains 145 patients. There are 70 in UAP, average age (56.73±9.95); 45 in SAP, average age (56.47±10.46). All these patients will accept coronary arteriogrphy to fix the severity of coronary stenosis and calculate the Gensini's score, which can present the severity of coronary stenosis; we choose the other 30 patients, average age (49.17±10.18), to form the control group , they have had coronary arteriography and verify that they don't have coronary stenosis. The patients in each group would be phlebotomized in elbow and detect the serum uric acid in the second day of being in hospital.The results of experiment: 1. there is a remarkable different in the level of SUA among the three groups.(F=20.333,P<0.01) After contrast between optional two groups, we found that the level of serum uric acid in UAP is higher than that of SAP and control group, but the level of serum uric acid in SAP has no obvious discrepancy from that in the control group. 2. divide the patients in UAP group and SAP group into lower group (<30) and higher group (≥30) according to their Gensini's score. The level of serum uric acid in both the lower and higher groups in the two groups has no remarkable discrepancy, the linear correlation analysis indicates that the level of serum uric acid has no correlativity with Gensini's score(P>0.05). Mixed the patients in the two groups into one, then divide them into lower and higher group according to the Gensini's score. We found that there is no obvious discrepancy in the level of serum uric acid in the two groups, the linear correlation analysis shows that the level of serum uric acid has no correlativity with Gensini's score(P>0.05). 3. divide the patients in UAP into single-vein stenosis and multi-vein stenosis according to the branchs of coronary artery stenosis in coronary arteriongraphy , we got that the level of serum uric acid in single -vein stenosis is (356.7±75.7mmo/L), in multi-vein stenosis is (348.3±67.0mmo/L), there is no obvious discrepancy.The result points out that the uric acid of the patients in UAP is higher than that in SAP and control group. It tells us that uric acid has a close relationship with the occurring of UAP, and also has the promoting function for the unstable anginal patient in the developing process of coronary artery disease from stablility to unstability. The uric acid is the metabolite of purine in nucleicacid of food and internal ribonucleoprotein nucleic acid. The main source of serum uric acid is the degradation of xanthine by dehydrogenase and xanthine oxidase. We also found out that it also have an intimate relation with the existence of coronary heart disease and such angiocardiopathy. The molecule of uric acid has a low physical solubility in blood, it's easy to separate out and sediment on the vessel wall when the consistency of uric acid in the blood is too high, and can lead to the direct damage of endangium. It may also promote the platelet aggregation by all kinds of body mechanisms and provocate inflammatory reaction of plaque, which is a important mechanism for changing of coronary arterial atheromatous plaque .It further pointed out that the level of uric acid doesn't affect the size of plague because the level of uric acid has nothing to do with the severity of coronary stenosis. yet it may deepen the severity of inflammatory reaction in plague to increase the unstability of plague, thus to promote the occurring of UAP. No matter the coronary artery disease of serious stenosis or slight stenosis, it tends to develop into unstability.It also indicated that uric acid doesn't influence the branchs of coronary artery stenosis ,because there is no remarkable difference in serum uric acid for the patients in single-vein stenosis and multi-vein stenosis group, Namely the level of uric acid doesn't affect the scope that coronary artery disease involved. The effect of raising the level of uric acid may happen on either the patient of single-vein stenosis or muti-vein stenosis, because uric acid may act as the motivating factor to participate the acute bout of coronary heart disease in the acute bout of UAP.Uric acid may be seen as the mark of molecular biochemistry in evaluating the stability of coronary artery disease for the patient of coronary heart disease, it also has a great significance in predicting the infaust angiocardiopathy event for the patient of coronary heart disease in clinical work. |
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