| The incidence of cardiovascular diseases has been on an increasing trend and become one of the major factors causing death among Chinese people as a result of the rapid economic development, urbanization, population ageing, and changes of the traditional dieting habit and way of life. In a long period in the future, it is expected that the incidence and mortality rates of cardiovascular diseases will be severely challenging, among which acute myocardial infarction(AMI) is a major cause. AMI is caused by necrosis of myocardial tissue due to continuous and severe ischemia. Pathologically it is usually caused by ulceration and break of the unstable coronary atherosclerotic plaques, which in turn lead to activation and aggregation of blood platelets, causing blood clots and vascular occlusion. It has been reported that inflammatory responses play a critical role in the occurrence, development, and break of unstable plaques. Inflammatory cells show significant activity to speed up the pathological process of arteriosclerosis, and involve in the myocardial remodeling after infarction, mainly by producing cytokine-mediated immune response for activated T lymphocytes.Objective: By measuring the levels of T cell subgroups, we are to investigate the effect of inflammation and immunological response in the development of AMI, the associations between these inflammatory markers and the pathological change of coronary arteries, and the impact of unbalanced ratios of T cell subgroups on AMI. We aim to further understand the course of AMI development, so as to seek a convenient and effective indicator for early diagnosis and prognosis of AMI.By detecting the changes of T cell subgroups in AMI patients taking compound Danshen dripping pills(CDDP) for one month,we are to explore its mechanism in improving the endothelial function of coronary arteries,decreasing the activation of inflammation,and delaying myocardial remodeling.Methods: A total of 60 AMI patients, who were hospitalized in the Cardiovascular Department of our hospital between December 2013 and September 2014, were enrolled in this study. They included 40 patients with normal heart function(Killip class I) and 20 with heart failure(Killip class II and III) after onset of the disease. Another 20 patients with unstable angina pectoris(UAP), 20 with stable angina pectoris(SAP), and 20 controls were also included. Excluded were those with hepatic and renal insufficiency; chronic infectious diseases; malignant tumors; autoimmune disease, connective tissue disease, and rheumatic disease; thyroid gland and adrenal diseases; other heart diseases including myocarditis, cardiomyopathy, endocarditis, and rheumatic heart disease; those taking anti-inflammatory medicine or immunosuppressant in recent three weeks; those having trauma or surgery in recent three months; those with peripheral vascular disease or peripheral vascular embolism; those allergic to contrast agent or refusing to undergo coronary angiography; those with cardiogenic shock; those with coronary artery bypass surgery or percutaneous coronary intervention(PCI); and those receiving thrombolytic therapy before PCI.Blood was drawn after fasting the next morning after being admitted into hospital for patients in the control, SAP and UAP groups; blood was obtained before emergency surgery after admission for AMI patients. Ethylenediaminetetraacetic acid(EDTA) was used to keep blood samples from clotting. T cell subgroup ratios in peripheral blood were detected by using flow cytometry. Compare the data of every group.And the myocardial infarction patients were selected as the research object, they were divided into the following groups. AMI experimental group(treated with CDDP) included 30 cases, in which the heart function after myocardial infarction control group included 20 cases, 10 cases were heart failure group after myocardial infarction. AMI control group(routine treatment) included 30 cases, in which the heart function after myocardial infarction control group included 20 cases, 10 cases were heart failure group after myocardial infarction. Patients in the AMI control group were administered with aspirin, Plavix, nitrate medicines, and atorvastatin as per the routine treatment for coronary heart disease. Diuretics were prescribed for patients with heart failure. AMI patients in the CDDP group took 20 pills by mouth immediately before undergoing PCI, while no pill was used in the control group. CDDP was also prescribed for the AMI controls after surgery with a dosage of 10 pills three times daily for four weeks. T cell subgroup ratios in peripheral blood were detected for the AMI control and CDDP groups using flow cytometry.Statistical analyses were performed using SPSS19.0, with rate or constitute ratio calculated for the data. T cell measurements were expressed as(x ± s). One way analysis of variance was used to compare values between multiple groups. P<0.05 was considered to be the threshold for statistical significance.Results:1 The percentage of CD3+ lymphocytes was higher in the SAP, UAP, AMI(Killip class I) and AMI(Killip class II and III) groups than in the control group, with statistical significance(P<0.05); there is no significant difference between the former three groups(P>0.05); The percentage in AMI(Killip class II and III) groups was higher than in others(P<0.05).2 The percentage of CD4+ lymphocytes was much higher in UAP, AMI and SAP groups than in the controls, with statistical significance(P<0.05); the percentage was higher in AMI(Killip class II and III) than in AMI(Killip class I) group, with statistical significance(P<0.05); no significant difference was found between AMI(Killip class I) and UAP groups(P>0.05).3 The percentage of CD8+ lymphocytes was lower in the UAP and AMI groups than in the SAP and control groups, and the percentage was lower in AMI(Killip class II and III) than in AMI(Killip class I) group, with statistical significance(P<0.05).4 The ratio of CD4+/CD8+ was higher in the UAP and AMI groups than in the SAP and control groups, and it was higher in AMI(Killip class II and III) than in AMI(Killip class I) group, with statistical significance(P<0.05).5 The percentage of CD3+, CD4+, and the ratio of CD4+/CD8+ decreased and the percentage of CD8+ increased one and four weeks after treatment in comparison to those before treatment in AMI patients with normal heart function, CDDP and routine treatment group. The changes in CDDP group was more remarkable, with statistical significance(P<0.05).6 The percentage of CD3+, CD4+, and the ratio of CD4+/CD8+ decreased and the percentage of CD8+ increased one and four weeks after treatment in comparison to those before treatment in the AMI patients with heart failure, CDDP and routine treatment group, with statistical significance(P<0.05). No significance was observed between CDDP and routine treatment groups one week after treatment(P>0.05). The changes in CDDP groups was more remarkable in comparison to the routine treatment group four weeks later, with statistical significance(P<0.05).Conclusion: This study detected that the percentages of CD3+, CD4+ and CD8+ lymphocytes and the changes of the CD4+/CD8+ ratio in AMI patients using flow cytometry. By comparison with other types of coronary heart disease, the association between T cell subgroup and the development of AMI was determined.1 T lymphocytes mediated immune and inflammatory response occurs throughout the development process of coronary atherosclerosis.2 The percentage of CD4+ lymphocytes and the ratio of CD4+/CD8+ increased while the percentage of CD8+ lymphocytes decreased in AMI patients, with the changes more remarkable in patients with heart insufficiency, indicating that abnormal immuno-inflammatory responses occurs in AMI patients, which takes part in the disease evolution. The detection of such changes may help to determine the status of the disease and the prognosis.3 CDDP may help to treat patients with AMI by way of decreasing the levels of CD3+ and CD4+ T cells, increasing CD8+ T cells, restoring the balance between CD4+ and CD8+ T cells, improving the immuno-inflamm- atory responses, alleviating the disease and improving prognosis. |
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