| IntroductionUnstable angina pectoris ( UAP ) is a group of diseases between stable angina and acute myocardial infarction. They often progress rapidly and result in acute myocardial infarction or cardiac sudden death at a rate of 10 ~ 20% within a year. The occurrence of UAP is due to the rupture of an atherosclerotic plaque or endothelial lesion of coronary artery , which leads to thrombosis. Vascular endothelial injury plays a critical role in the mechanism. In recent years, investigating the changes of vascular endothelial function and looking for the measures to protect the endothelium in patients with coronary heart disease have become hot spots. Thrombomodulin(TM) has been suggested as a sensitive marker of endothelial cell injury. The plasma level of TM increases in many diseases with endothelial lesions. There have been few studies on the variations of plasma levels of TM in UAP. Therefore , we detected the plasma levels of TM in patients with UAP and analyzed the relation between TM and coronary artery lesion degree and that between TM and the risk factors of coronary heart disease. In the meantime , we investigated the changes of TM induced by the anticoagulants in the patients undergoing interventional therapy. Our experiment is to explore the pathogenesis mechanism of coronary heart disease and the effects of anticoagulants on vascular endothelialfunction.Materials and MethodsAll the 30 patients with UAP were diagnosed by coronary angiog-raphy and underwent interventional therapy. 23 cases were male, 7 were female. According to anticoagulants administration after operation, the patients were divided into 2 groups randomly: low molecular weight heparin ( LMWH) group and unfractionated heparin ( UFH) group 15 cases respectively. The control group included 30 patients with normal coronary artery, 20 cases were male, 10 cases were female. The age and sex were matched in UAP (including subgroup) and the control group. The patients with acute myocardial infarction, diabetes, recent operation, trauma, connective tissue disease, malignancy, severe liver and kidney disease and those under LMWH or UFH treatment before procedure were excluded.Selective coronary angiography was performed by Judkins technique. The diagnostic criteria of coronary heart disease was that the stenostic percentage of diameter in the diseased coronary artery was > 50%. Gensini scoring system was adapted to determine the coronary disease lesion degrees. The score of control group was 0. The interventional procedures were performed by conventional methods. The two groups received interventional therapy were administered with LMWH 0.4 ml subcutaneously, once per 12 hours and continuous intravenous UFH 800 -1000U/h for 5 days respectively. After the procedure, the patients of the two groups received conventionally nitrates and/or calcium channel blocker. Fasting venous blood was obtained on the second day after the admission in all patients, and on the 2nd,3rd, 7th day after the procedure in the UAP group. TM was measured by ELISA. The additional venous blood was obtained on the second day after the admission to detect glucose, fibrinogen, total cholesterol, and so on.ResultsThe plasma levels of TM , TC, LDL, Fig, Glu and ApoB were significantly higher in UAP group when compared with control group (TM 5.72 ±2.26 ng/ml versus 3.77± 1.17 ng/ml,p <0.05). Similar results were also found in single vessel disease group, double or three vessels disease group when contrasted with control group respectively , but there was no dramatic difference between the two groups ( p> 0. 05 ). In contrast with non - hypertensive patients, the plasma levels of TM in patients with hypertension was significantly higher ( p<0.05).The plasma concentrations of TM in patients undergoing coronary angiography showed markedly positive correlation to age, the duration of hypertension, total cholesterol and the scores of coronary artery lesions ( r = 0.235 - 0.485, p < 0.05 ) , but no significant relation to the number of lesion ves...
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