A Study On Relationship Between Fibrinolytic System And Carotid Atheroscerosis

Objectives1. To explore the effects of blood fibrinolytic system and other factors on the carotid AS2. To investigate the relationship of the mRNA and antigen expression of plasminogen activator inhibitor- l(PAI-l), monocyte chemoattractant protein-1(MCP-1) and intercellular adhesion molecule-1 (ICAM-1) with the pathogenesis of carotid AS plaqueMaterials and methods1. 192 inpatients from department of neurology in our hospital was divided into carotid AS group(94 patients) and normal carotid group(98 patients) by B-mode ultrasound imaging method. Plasma tissue plasminogen activator(t-PA) and PAI-1 activities were measured by chromogenic substrate assay, fibrinogen and D-dimer concentrations by immunoturbidimetry, Hey concentration by fluorescence polarization immunoassay, folate concentration by electrochemiluminescence. In the meantime total cholesterol(TC), triglyceride(TG), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), apolipoprotein Al(apoAl) and apolipoprotein B(apoB) concentrations were measured by routine methods. The monovariate analysis and multivariate logistic regression model were used to evaluate the effects of fibrinolytic activity and other related factors on the carotid AS. Pearson correlation analysis was used to analyse the correlation between the risk factors of the carotid AS.2. The specimens of carotid atherosclerotic plaques and normal arterial walls from carotid endarterectomy, liver transplantation and autopsy wereclassified as normal arterial walls or macroscopically normal areas(MNAs) group(12 specimens), early lesions(ELs) group(8 specimens) and advanced lesions(ALs) group(20 specimens). Antigen and mRNA of PAI-1, MCP-1 and ICAM-1 were measured by immunocytochemistry and hybridization in situ respectively. Analysis of variance was used to evaluate the mRNA and antigen's changes of PAI-1, MCP-1 and ICAM-1 in the carotid AS plaques. Pearson correlation was used to evaluate the correlation between PAI-1, MCP-1 and ICAM-1. Results:1. TC, TG, LDL-C, apoB, Hey, D-dimer, fibrinogen concentrations and PAI-1 activity increased significantly, HDL-C, apoAl concentrations and t-PA activity decreased significantly in carotid AS group as compared with those in control group(P<0.05). Although folate concentration in carotid AS group decreased as compared with that in control group, it didn't reach the statistic significance(P=0.055). The percentages of patients with the history of smoking, hypertension, diabetes mellitus and cerebrovascular disease in carotid AS group were significantly higher than the percentages of those in control group(P<0.01). The percentages of patients with the history of drink and coronary heart disease in carotid AS group were a little higher than those in control group, but they didn't reach statistic significance(P>0.05).2. High PAI-1 activity, low t-PA activity, smoking, hypertension, hypercholesterolemia and hyperhomocysteinemia were associated with carotid AS. The odds ratios were 1.69, 0.29, 3.93, 2.42, 1.66 and 1.06 respectively.3. Plasma PAI-1 activity and fibrinogen concentration increased and t-PA activity decreased significantly in smokers than those in nonsmokers (P<0.05). Plasma PAI-1 activity in drinkers increased significantly than thatin nondrinkers. Plasma t-PA activity in patients with hypertension decreased significantly than that in patients without hypertension. Plasma fibrinogen concentration in patients with diabetes mellitus increased significantly than that in patients without diabetes mellitus.4. PAI-1 activity was correlated with fibrinogen and D-dimer levels, inversely correlated with t-PA activity. The correlation coefficients were 0.158, 0.348 and -0.413 respectively; t-PA activity was inversely correlated with PAI-1 activity, LDL-C and D-dimer levels. The correlation coefficients were -0.413, -0.212 and -0.161 respectively; Hey concentration was correlated with TC concentration, inversely correlated with folate concen...