Relationship Between Platelet Parameters And Inflammatory Reaction In Patients With Coronary Heart Disease And Diabetes Mellitus

PART I Relationship between Platelet Parameters and C-reaction Protein in Patients with Coronary Heart Disease and Impaired Glucose ToleranceObjective:Impaired Glucose Tolerance and Type2diabetes are very frequent in Coronary Heart Disease. Activated platelet plays an important role in atherosclerosis, thrombosis, and inflammation. The platelet in patients with Type2diabetes also called "diabetic platelet".C-reaction protein plays an important role in the developmental progress of atherosclerosis and type2diabetes. There were few reports on platelet function and C-reaction protein in the stage of impaired glucose tolerance in patients with coronary artery disease. The aim of this study was to investigate the change of platelet parameters and C-reaction protein in patients with coronary Heart disease and impaired glucose tolerance.Methods:This study cohort included39consecutive patients with patients with coronary Heart disease and impaired glucose tolerance. These patients come from the (Acarbose Cardiovasculer Evaluation)ACE test in Renmin hospital of Wuhan University from Dec2009～Sep2012. These patient was divided into group A included25men and14women, aged50～76years(63±8ys). Group B (normal control group) included patients with PSVT (Paroxysmal supraventricular tachycardia),10men and7women, aged50～71years(62±5ys).These patients received RFCA(Catheter radiofrequency Ablation operation in2nd department of Cardiology, Renmin Hospital of Wuhan university from Sep2011to Sep2012, with age above50ys. The observed parameters were collected at initial admission. These parameters included sex,age,history,CTnI, CK-MB, Myo)、oral glucose tolerance tes、TC, TG, HDL, LDL, Lpa,hs-CRP,blood parametes,EKG,reports of SCA or coronary CA.Statistical analysis:Results were presented as±SD for continuous normally distributed variables, as median for continuous non-normally distributed data, and as percentages for categorical data. Significance was assumed with a two-sided p value of below0.05. We tested continuous variables by one-way ANOVA for between-group comparisons and Student’s t-test for within-group comparisons. If a normal distribution of variables was not presented, the Mann-Whitney Test was used for testing treatment-group differences and the Coefficients of correlation (r) were calculated by the Spearman’s rho correlation analysis. The data were analyzed using SPSS for windows10.0(SPSS Inc.).Results:1. The subjects in group A had higher levels of fasting plasma glucose and lower levels of high-density lipoprotein cholesterol compared with subjects in group B.2. The subjects in group A had higher levels of MPV、PDW、P-LCR and hsCRP and lower levels of PLT compared with subjects in group B.3. Spearman’s rho correlation analysis revealed that there were relationships between platelet parameters and hsCRP in patients with coronary Heart disease and impaired glucose tolerance, respectively. PLT was negatively related to MPV、PDW and P-LCR. There were positive relationships between P-LCR、PDW and MPV. The levels of hsCRP were negatively related with PLT and positively related with MPV、 PDW and P-LCR.Conclusions:1. There are higher levels of platelet activity and hsCRP in patients with coronary Heart disease and impaired glucose tolerance compared with normal control group. The high levels of platelet activity and hsCRP may induce coronary atherosclerosis and thrombosis.2. The relationships between platelet parameters and hsCRP in patients with coronary Heart disease and impaired glucose tolerance imply cooperative effects in the development of atherosclerosis. This should be paid attention. PART Ⅱ:Relationship between Platelet Parameters and C-reaction Protein in Patients with Coronary Heart Disease and Diabetes MellitusObjective:The disorders of glucose metabolism in coronary heart disease are more frequent in P.R.China than in west countries. The combined presence of disorders of glucose metabolism and coronary heart disease is up to80%. The proportion of abnormal glucose metabolism in patients with acute myocardial infarction is very high. The most glucose metabolism disorders are caused by persistent hyperglycemia, rather than a transient hyperglycemia induced by stress. Activated platelet plays an important role in atherosclerosis, thrombosis, and inflammation. The platelet in patients with Type2diabetes also called "diabetic platelet". In recent years, studies have shown that platelet coagulation is still involved in the inflammatory response. C-reactive protein is a non-specific marker of the systemic inflammatory response. Serum C-reactive protein concentrations may reflect inflammatory mediator activities in vivo. And they are proportional to the degree of inflammation and tissue damage. CRP is the most reliable atherosclerosis inflammatory markers. The study on platelet parameters and C reactive protein in patient with coronary heart disease combined with diabetes mellitus is few. In the first part of this study, we performed the study on the relationship between platelet parameters and hsCRP in patients with coronary heart disease and abnormal glucose tolerance, and we found high platelet activity and C reactive protein levels, and the relationship in patients with coronary heart disease and impaired glucose tolerance. This part of study will further detect blood platelet parameters, hsCRP and serum lipids in patients with coronary artery disease combined with type2diabetes.Methods:This study included group A (patients with coronary artery disease combined with type2diabetes) and group B (patients with coronary artery disease and without type2diabetes).98consecutive patients with patients with coronary heart disease and T2MD and112consecutive patients with coronary heart disease and without T2MD. These patients come from the inpatients in2nd department of Cardiology, Renmin hospital of Wuhan University from Aug2009-Aug2012. These210patients included173men and37women, aged34～87years(61±12ys). The observed parameters were collected at initial admission. These parameters included sex,age,history,CTnI, CK-MB, Myo)、 oral glucose tolerance test, TC, TG, HDL, LDL, Lpa, hs-CRP,blood parametes,EKG, reports of SCA or coronary CA. Statistical analysis:Results were presented as x±SD for continuous normally distributed variables, as median for continuous non-normally distributed data, and as percentages for categorical data. Significance was assumed with a two-sided p value of below0.05. We tested continuous variables by one-way ANOVA for between-group comparisons and Student’s t-test for within-group comparisons. If a normal distribution of variables was not presented, the Mann-Whitney Test was used for testing treatment-group differences and the Coefficients of correlation (r) were calculated by the Spearman’s rho correlation analysis. The data were analyzed using SPSS for windows10.0(SPSS Inc.).Results:1. The subjects in group A had higher levels of fasting plasma glucose, higher proportion of women compared with subjects in group B.2. The subjects in group A had higher levels of MPV、PDW、P-LCR and hsCRP, and lower levels of PLT compared with subjects in group B.3. Spearman’s rho correlation analysis revealed that there were relationships between platelet parameters and hsCRP in patients with coronary Heart disease and T2DM, respectively. PLT was negatively related to MPV、PDW and P-LCR. There were positive relationships between P-LCR、PDW and MPV. The levels of hsCRP were negatively related with PLT and positively related with MPV、PDW and P-LCR.Conclusions:1. There are higher levels of platelet activity and hsCRP in patients with coronary Heart disease and T2DM compared with normal control group. The high levels of platelet activity and hsCRP may induce coronary atherosclerosis and thrombosis.2. The relationships between platelet parameters and hsCRP in patients with coronary heart disease and T2DM imply cooperative effects in the development of atherosclerosis. This should be paid attention. Part III:A New Simplified Immediate System Inflammatory Score for Type2Diabetic Patients Presenting with ST-segment Elevation Acute Myocardial InfarctionObjective:Patients with diabetic mellitus have worse outcomes after acute myocardial infarction (AMI) occurs than non-diabetics. The body condition changes fast in patients with T2DM and AMI and the arrhythmia, heart failure and sudden death extremely easily occur, so the prognosis is usually poor. The prognosis assessment for patients with T2MD and acute myocardial infarction should be paid more and more attention. Early prediction of the degree of risk for new admissions of patients with acute myocardial infarction can guide the next step of the examination and treatment programs and help to reduce the incidence of complications during hospitalization. The early systemic inflammatory response variables (body temperature, heart rate, respiratory rate, and white blood cell count) were collected in diabetic patients with acute myocardial infarction in this study. The ROC curves were drawn to evaluate the power of various systematic inflammatory response variables and discriminatory combining power of4variables to predict the prognosis of patients with acute myocardial infarction.Methods:This study cohort included67consecutive diabetic patients with STEMI during8hours from symptom onset. These diabetic patients with STEMI,53men and14women, aged34～83years(63±15ys), were admitted to the department of cardiology in Renmin Hospital of Wuhan University between Dec2007and Sep2012. An inflammatory score model was developed for predicting in-hospital major adverse events using parameters available at initial admission. These parameters including sex,age,history,CTnI, CK-MB, Myo、TC, TG, HDL, LDL, Lpa, hs-CRP,blood parametes, EKG, reports of SCA or coronary CA.body temperature, heart rate and respiratory rate were collected at admission.Statistical analysis:Results were presented as x±SD for continuous normally distributed variables, as median for continuous non-normally distributed data, and as percentages for categorical data. Significance was assumed with a two-sided p value of below0.05. We tested continuous variables by one-way ANOVA for between-group comparisons and Student’s t-test for within-group comparisons. If a normal distribution of variables was not presented, the Mann-Whitney Test was used for testing treatment-group differences and the Coefficients of correlation (r) were calculated by the Spearman’s rho correlation analysis. The data were analyzed using SPSS for windows10.0(SPSS Inc.). ROC(receiver operating characteristic) curves analysis was used to analyze the efficacy of the body temperature, heart rate, respiratory rate and white cell count in the prognosis in diabetic acute myocardial infarction.Results:ROC curves (receiver operating characteristic curve, c-statistic) analysis revealed that body temperature, heart rate, respiratory rate and white cell count can predict in-hospital major adverse events with AUC0.757±0.064,0.712±0.077,0.779±0.071, and0.664±0.080, p<0.05, respectively. ROC curves analysis also revealed that the combining predictive ability of the four parameters was strong (c=0.88) and it is better than single variable predictive ability.An inflammatory score model was developed using the four parameters above to predict in-hospital major adverse events according to the best cutoff values as fellow:(1) BT<=36.℃;(2) HR>83bpm;(3) RR>21bpm; and (4) WBC>11.5×109/L. There was a relationship between inflammatory scores and in-hospital major adverse events (p=0.000)。The rate of major adverse events with score2～4was higher than that with score0～1,71.4%vs.18.2%, p=0.000. The odds ratio(OR) was11.25(2.80,45.16),p=0.000。These patients with score0～1could be classified into low-risk person, while these patients with score2～4could be classified into high-risk person.Conclusions:1. The parameters including body temperature, heart rate, respiratory rate and white cell count which were collected on admission can predict major adverse events post-AMI in Type2diabetics.2. The simple systematic inflammatory score for major adverse events post-AMI in Type2diabetics showed excellent predictive capacity in a population based on cohort of patients with STEMI during8hours from symptom setup.