Changes And Meanings Of Serum Soluble P-selectin And C-reactive Protein In Patients With Acute Coronary Syndromes

INTRODUCTIONIt has been established that atherosclerotic plaque is ruptured in acute coronary syndromes(ACS) , leading to thrombus formation. And the process is associated with acute inflammation response including platelet activation. Platelet activation plays an important role in the development and therapy of acute myo-cardial infarction ( AMI) and unstable angina pectoris ( UAP). P - selectin is a cellular adhesion molecule belonging to the selectin family. It is rapidly expressed on the surface of activated platelets and endothelial cells when inflammation and injury occur and mediates the adherence of monocytes and leukocytes to platelets and the vascular endothelium, leading to platelet activation. P - selectin is a marker of platelet activation. C - reactive protein ( CRP) , an acute phase reactant synthesisted by liver, the concentration of which is a precise and objective index of white cell activation and inflammatory activity. The present study was undertaken to determine serum soluble P - selectin ( sP - selectin) level in patients with AMI, UAP and controls, aim at clarify the relationship between sP - selectin level and ACS. In order to illustrate whether sP - selectin level is correlate with inflammation response, we also measured serum sP - selectin and CRP level during different time after treatment with percutaneous coronary intervention ( PCI) , as well as understand the pathophysiologic mechanism of P - selectin for the development of ACS.SUBJECTS AND METHORDSSubjects We studied 21 patients with UAP, 22 patients with AMI and 23 controls. And 14 patients with AMI underwent PCI and 13 patients with AMI treated without reopening of an occluded vessel were also researched.Measurements 2 - millititer venous blood of all patients were drawn by needle aspiration before therapy. In controls, 2 - millititer blood samples were collected in the morning after an overnight fast. 2 - millititer blood samples from patients treated with PCI were taken immediately after PCI, and then 2, 4, 6, 8, 10, 12, 18 and 24 hours after treatment. 2 - millititer blood samples form patients treated without PCI were drawn after 6,12 and 24 hours after therapy. Levels of sP - selectin and CRP were measured with ELISA. Blood chemistry examinations were determined with routine clinical laboratory test. The height and the weight of each subject was measured, the body mass index (BMI) was calculated as BMI = weight (kg)/ height (m)2.Statistical analysis All data were expressed as the mean ± SD. Differencesin nonparametric data were compared with)(2 test. One - way ANOVA was usedto compare differences of mean between groups. Pearson correlation analysis wasused to evaluate the correlation between variables. All statistical tests were two-tailed and a p value 0.05 was regarded as statistically significant..RESULTS1. There was no significant difference between groups for clinical characteristics.2. The mean sP - selectin level was significantly higher in patients with AMI and UAP than controls, no significant difference was observed between AMI and UAP groups.3. There was no significant difference between different therapy groups for characteristics and the mean levels of sP - selectin before therapy.4. Therapy with PCI resulted in a significant decrease of sP - selectin con-centrations during the first 2 hours after treatment. Then increase of levels was observed, and reached a level of peaking during the first 12 hours after treatment and was followed by decrease near to the baseline level during the first 18 hours.5. Steady increase of sP - selectin levels was showed in patients with AMI treated without PCI throughout the observation period.6. Compared with the level before PCI, CRP concentration of each time after treatment was elevated and reached a level of significance during the first 18 and 24 hours after treatment.7. Correlation analysis showed that there was no significant correlation between serum sP - selectin and CRP.DISCUSSIONAtherosclerosis is pathological basic of most coronary heart disease (CHD) , and is an inflammation disease that resulted from an injury that leads to an increase in the adhesiveness and permeability of the endothelium to leukocytes or platelets. P - selectin mediates the earliest leukocyte rolling during the inflammation response. P - selectin can also mediate platelet adhesion by binding platelet - P - selectin with PSGL - 1 expressed on the surface of endothelial cells and leukocytes. This study confirmed that P - selectin plays an important role in the development and course of ACS and there are higher levels of activated platelet in ACS. On the other hand, no significant difference was observed between AMI and UAP groups that suggested the same mechanisms and patho-genesis between AMI and UAP. It has been reported that increased P - selectin levels were associated with increasing risk of future coronary artery disease and were an indicator of a poor prognosis in patients with MI. Recently, both polymorphism of the PSGL -1 gene and animal research showed that drugs targeted against P - selectin can be effective in CHD, supporting our conclusion.PCI is established method to achieve reopening of an occluded vessel. Despite this observation, there has been concern that reperfusion itself may have some deleterious effects on the myocardium by inducing an acute inflammatory response, leading to a secondary reperfusion injury in addition to the ischemia -...