The Relationship Of Platelet Activation State And The Inflammatory Reaction In Patients With Coronary Heart Disease

Objectives: To observe the platelet activation state, the inflammatory factors and therelationships between them in patients with coronary heart disease(CHD), and to show theevidence of therapeutic effects on anti-inflammatory and anti-thrombus at acute stage ofCHD. Then to discuss if the platelet activation state and the maker of inflammatoryreaction may provide the evidences of diagnosis, therapeutics and judgment on prognosis.Methods: Collect 150 in patient cases with CHD and 53 healthy adults according to theselective standards and exclusive standards. With the same elementary therapeutics wedivided 150 patients with CHD who was diagnosed clearly according to guideline ofACC/AHA and 53 healthy adults to four groups: The first group(normal control), 53cases; The second group, 47 patients with stable angina pectoris(SAP) (bayer-aspirin100mg/d); The third group,50 patients with unstable angina pectoris (UAP)(bayer-aspirin 100mg/d+Fragmin 5000u Q12h); The forth group, 53 patients with acutemyocardial infarction(AMI) (bayer-aspirin 100mg/d+Fragmin 5000u Q12h+Plavix75mg/d). Elementary therapeutics includes medicine such as statins(lescol 40mg/qn),antagonist of Ca²⁺,β-blocker, angiotensin converting enzyme inhibitor and nitrate etc. Thefasting blood sugar, lipid, blood platelet count(BPC×10⁹/L), mean platelet volume(MPVfl), platelet aggregation of plasma, 11-dehydro thromboxane B2(11-DH-TXB₂ pg/ml)ofurine,high sensitive C reactive protein(hsCRP mg/l) of plasma, and fibrinogen(Fg g/l)were detected besides the routine examination when all the patients admitted to thehospital. The platelet aggregation were examined by turbidimetry, inductor is adenosinediphosphate(ADP 10umol/l) and arachidonic acid(AA 20mg/l). The enzyme linkedimmunosorbent assay was used to examine hsCRP of plasma and 11-DH-TXB₂ of urine.Results: 1. BPC of the AMI group is significantly lower than that of the normalcontrol, the SAP group and the UAP group, while the MPV of the AMI group issignificantly higher than that of normal control, the SAP group and the UAP group.Moreover the MPV of the AMI group is significantly positive correlation with themaximum platelet aggregation test(MPAgT) induced by ADP(r=0.333, p=0.015)and byAA(r=0.330, p=0.016), and the 11-DH-TXB₂ of urine(r=0.434, p=0.001) at the acute stage.2. The plasma Fg of the AMI and UAP group were significantly higher than that of thenormal control and the SAP group (P＜0.01), moreover plasma Fg of the AMI and UAPgroup were significantly positive correlated with MPAgT induced by ADP(r=0.304,p=0.002)and by AA(r=0.283, p=0.004), and the 11-DH-TXB₂ of urine(r=0.368, p=0.000)at the acute stage.3. The significantly difference within the level of plasma hsCRP of the normal controland that of all groups with CHD (include the SAP, UAP, AMI groups,F=61.688, P=0.000),the AMI group is significantly higher than the UAP group (P=0.000),SAP group (P=0.000)and the normal control(P=0.000), the UAP group is significantly higher than the SAPgroup (P=0.003) and the normal control(P=0.000), the SAP group is significantly higherthan that of the normal control(P=0.046);the major adverse cardiac events of higher levelof plasma hsCRP is significantly higher then the lower level of plasma hsCRP of allgroups with CHD (8.77% and 27.95%, P=0.009); The level of plasma hsCRP of all thepatients with CHD is significantly positive correlated with the MPAgT induced byADP(r=0.473, P=0.000) and AA(r=0.434, P=0.000), 11-DH-TXB₂ of urine (r=0.554,P=0.000) at the acute stage.4. The MPAgT induced by ADP and AA of the UAP and AMI group were significantlyhigher than that of the normal control and the SAP group (P＜0.001).5. The 11-DH-TXB₂ of urine in the normal control and all groups with CHD issignificantly difference with each other (F=61.201, P=0.000), the AMI group issignificantly higher than that of the UAP (P=0.000),SAP group (P=0.000) and the normalcontrol(P=0.000), the UAP group is significantly higher than that of the SAP group(P=0.003) and the normal control (P=0.000), the SAP group is significantly higher thanthat of normal control(P=0.046).6. There were significantly changes before and after treatment in the level of plasmahsCRP,MPAgT induced by ADP and AA, 11-DH-TXB₂ of urine of all the patients withCHD.7. The MPAgT induced by ADP and AA of the SAP,UAP,AMI group significantly decreased after treatment, especially in the AMI to UAP group, the UAP to SAP group.Conclusions:1. There were significantly increased in the MPAgT induced by ADP and AA and11-DH-TXB₂ of urine of patients with CHD from steady state to acute coronary syndrome(include the group of UAP and AMI).2. There were significantly decreased in BPC and significantly increased in MPV of theAMI group at the acute stage, moreover the MPV of the AMI group is significantlypositive correlated with the level of plasma hsCRP, the MPAgT induced by ADP and AA,and the 11-DH-TXB₂ of urine.3. There was significantly increased in the level of plasma hsCRP of patients with CHDfrom steady to acute stage, moreover the level of plasma hsCRP may predict theprognosis in the near future(＜30days).4. Statins can decrease the level of plasma hsCRP.5. The therapy of inhibiting the platelet aggregation combined Plavix and aspirin issignificantly superior to aspirin alone.