| Objective To detecte the expression of Fg,D-dimer,C-reactive protein(CRP), Tumor necrosis factor-α(TNF-α),Monocyte chemoattractant protein-1(MCP-1),Tissue factor(TF) and monocyte tissue factor(TF m RNA) in patients with Chronic thromboembolic pulmonary hypertension(CTEPH),to understand coagulation status of CTEPH,the relationship between CRP,TNF-α,MCP-1 and the severity of the disease,as well as TF.And to investigate the effects of monocyte tissue factor and inflammatory cytokines on the development of CTEPH cases.Methods Ten cases confirmed the diagnosis of CTEPH,20 cases with Acute pulmonary embolism(PTE) and 15 cases of other types of Pulmonary hypertension(PH) were enrolled into the study from June 2013 to October 2014 in the First Affiliated Hospital of Fujian Medical University,at the same time,20 cases were enrolled as the control group.Freezing method was used to determine the content of Fg,with immune turbidimetric method for determining the content of D-dimer and CRP.The level of TNF-α,MCP-1,TF antigen were measured with enzyme-linked immunosorbent assay(ELISA) method,TF activity was measured with chromogenic substrate method in plasma.Percoll density gradient centrifugation separated of peripheral blood mononuclear cells.The expressions of monocyte TF m RNA were tested by reverse transeriptase-polymerase chain reaction(RT-PCR).At last, the detection of indicators were used to analysis correlation.Results(1)In CTEPH cases,the exprssion of Fgrinogen(4.404±0.563) and D-dimer(1.075±1.507)levels were higher than that of the control group(2.668±0.425,0.181±0.076),which the Fg levels increased demonstrate significantly(P=0.0001<0.01),elevated D-dimer levels showed no significant difference(P=0.390>0.05).The mean pulmonary arterial pressure(m PAP) ofCTEPH casess were 79.7 ± 21.193 mm Hg,There was a significant positive correlation(r=0.843, P=0.002<0.05) between m PAP and Fg level in CTEPH casess,while D- dimer levels was not correlated(r=-0.082, P=0.821>0.05).(2)In CTEPH cases,the exprssion of CRP(26.440±5.175)were higher than normal(2.417±1.707) and showed a significant difference(P=0.0001<0.01),at the same time,there were significantly correlated(r=0.922, P=0.001<0.05) between m PAP and CRP levels.The exprssion of TNF-α(32.340±4.525),MCP-1(45.487±16.522) levels were higher than normal(12.116±7.404,22.267±8.594) and both showed a significant difference(P=0.0001﹤0.01,P=0.008﹤0.01); Among cases with CTEPH,m PAP and MCP-1 levels were significantly correlated(r=0.661,P=0.037<0.05),while TNF-α was not correlated(r=0.487,P=0.154>0.05).(3) In CTEPH cases,the exprssion of TF activity(24.350±6.103) and TF antigen(45.677±12.061) were higher than control group(20.236±3.293,27.924±3.333),which TF antigen levels increased significantly(P=0.006<0.01),TF activity increased showed no significant difference(P =0.318>0.05).In CTEPH cases,the exprssion of tissue factor(0.332±0.019) on monocytes in blood were higher than that of the control group(0.248±0.007),the difference was statistically significant(P=0.0001﹤0.01),and there was a positive correlation with TF antigen content(r=0.826, P=0.003<0.01).CRP(r=0.733,P= 0.016 <0.05),TNF-α(r=0.662,P=0.037<0.05),MCP-1(r=0.696, P=0.025<0.05) are all associated with plasma TF antigen content in patients with CTEPH.Conclusion In CTEPH cases,tissue factor on monocytes in blood were higher and significantly positively correlated with plasma TF antigen content,suggesting that blood-borne tissue factor mainly come from mononuclear cells.TF,CRP,TNF-α and MCP-1 may play an important role on the development of CTEPH involving the Inflammation- coagulation- thrombosis cycle. |
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