The Effect Of Tongxinluo Combined Statins On Peripheral Blood Endothelial Progenitor Cells In Patients With Coronary Heart Disease

Objective:The incidence of coronary heart disease (CHD) with high mortality is still increasing significantly. Endothelial progenitor cells(EPCs) are precursors of endothelial cells,which play an important role in angiogenesis and the maintenance of the integrity of endothelial function. EPCs participate in repair of danaged endothelial injury,which through differentiating into mature endothelial cells. Studies have shown that the number of EPCs in peripheral blood of patients with coronary heart disease decreased,and are closely related with multiple coronary heart disease risk factors(age,sex,hypertension,diabetes,smoking,abnormal cholesterol,premature family history of coronary heart disease). Researches also show that the vascular endothelial condition and prognosis can be improved by increasing the number of EPCs of patients.In recent years,the research that the drugs improve the function and number of EPCs has become the new hot spot.This study was designed to observe the number of EPCs in patients with coronary heart disease of different levels and the influence of Tongxinluo capsule and stains on EPCs,to provide the basis for clinical medicine and in-depth study of the mechanism of effects of drugs on EPCs.Method:60 patients with CHD during hospitalization from Mar 2010 to Oct 2010 in Department of Cardiology of the Second Hospital of Tianjin Medical University were enrolled,who were all diagnosised through coronary angiography.The clinical infor-mation of patients were all collected,including age,sex,smoking,drinking,hypertensio n, diabetesmellitus,ECG,echocardiography,coronary lesions,liver and kidney function, blood lipids,Blood Routine test,etc. The study were divided into two groups by rando-mized block design.One group(A) was given fluvastatin(40mg/d) for four weeks; Another group (B)was given fluvastatin(40mg/d) and Tongxinluo pills(4 pills/tid) for four weeks.The study were treated with conventional blood 2ml,centrifuged in 2 hours.After repeatad centrifugation plus washing,the blood were incubated for 10 mi-nutes with CD34,CD133 antibodies.And then double-antibody-positive cells (proge- nitor cells)are counted by flow cytomery. Selected patients were given the conve-ntional treatment again after four weeks to review the number of progenitor cells,ECG,and other basic information were also colected again.All basic information and the number of progenitor cells before and after treatment were analysised.Results:1. The patients were divided into two groups by coronary lesions,50%-75% stenosis group and>75%stenosis group.For the two groups,there was significant difference on the number of EPCs(P< 0.05);The LDL, HDL of two groups have significant difference(P< 0.05); The Cr,Age,ALT,CK-MB,NEU%,HGB of two groups were not significantly different (P> 0.05)2. The number of EPCs between the smoking group and the non-smoking group were signifiantly different(P< 0.05); The number of EPCs between the diabetes group and the non-diabetes group were signifiantly different(P< 0.05).3. The Age,Gensini score,Blood sugar,TC,LDL,UA were significantly negatively related with the number of EPCs(P< 0.05);The HDL has a positive correlation with the number of EPCs,but it is not significant (P> 0.05)4. The difference is significant in the number of EPCs for the A and B group patients before and after treatment(P=0.000); The difference is not significant in the number of EPCs between A and B group before treatment (P=0.482); The difference between A and B group is significant in the number of EPCs after treatment (P=0.018)Conclusions:1. For the patients with different coronary lesions,the number of EPCs were significantly different,and the number of EPCs was positively correlated with coronary lesions.The number of EPCs may become one reference standard to determine the severity of coronary lesions.2. The numbers of HDL between different groups divided by coronary lesions were significantly different.The result suggests that the protective effect of HDL on coronary,and also that to increase the number of HDL may prevent or delay Athe-rosclerosis and to provide a new way of preventing Atherosclerosis. 3. Fluvastatin can significantly improve the number of EPCs in patients with coronary heart disease,and Tongxinluo combination with fluvastatin can have more obvious improvement for the number of EPCs.In clinical,in the basis of medicine treatment, Tongxinluo added will give a better result.4. The number of EPCs in patients with coronary heart disease has a significant negative correlation with low-density lipoprotein.The therapy to control blood lipoprotein in patients with CHD shoud be strengthened,especially to control the level of low-density lipoprotein.5. The analysis of different groups including smoking,diabetes and so on, displays smoking and high blood sugar have significant influence on the number of EPCs. The correation analysis of different risk factors,incuding Age,LDL and so on,displays that Age,Gensini score,Blood sugar,TC,LDL and UA were signif ica-ntly negatively related with the number of EPCs.the result suggests that to strengt-hen the control of these risk factors is necessary.