The Relationship Between P-selectin And Aspirin Resistance In Patients With Coronary Heart Disease

BackgroundCoronary heart disease can cause serious damage to human body health and quality of life. In recent years, with the improvement of living standards, the incidence of coronary heart disease has increased year by year. Inflammatory mechanism plays an important role in the formation and development of coronary artery atherosclerosis, which can result in the injury of vascular endothelial cells, platelet activation, plaque instability or rupture, secondary thrombosis and subsequent vascular obstruction. Aspirin as a kind of antiplatelet drugs have been widely used in the primary and secondary prevention of coronary heart disease. However, there are still the occurrence of adverse cardiovascular events after some patients have used oral aspirin(0.1g/d), for example unstable angina, acute myocardial infarction and sudden cardiac death. Laboratory testing of platelet activity or aggregation rate is also found that aspirin fails to reach the effective inhibition on platelet. As a result, someone put forward the conception of aspirin resistance(AR). P-selectin is one of the important members of the selectin family of cell adhesion molecules. It expresses on the surface of stimulated endothelial cells and activated platelets.As an inflammatory indicator which can reflect the degree of vascular endothelial cell injury and platelet activation. P-selectin as an important factor of starting and maintaining inflammation, may through inflammatory mechanisms participate in the occurrence of excessive platelet activation of the patients with AR.ObjectiveTo investigate the correlation between P-selectin and aspirin resistance(AR) in patients with coronary heart disease and statistic other independent risk factors for AR.MethodsWe enrolled 90 patients with coronary heart disease who were hospitalized in Geriatric Cardiology of Provincal Hospital Affiliated to Shandong University from September 2014 to September 2015. They have used oral aspirin(0.1g/d) for at least two weeks. The fasting venous blood of patients were drawed after admission and platelet inhibition rate was detected with Thrombelastography (TEG). Patients were divided into two groups according to their inhibition rate:Aspirin Sensitive (AS) group and AR group. ELISA was used to detect the expression level of serum P-selectin in the two groups. Difference between groups was detected with independent sample T-test or chi-square test. The independent risk factors of AR were analyzed in multivariate logistic regression analysis.Results1. The incidence of AR. Enrolled 90 patients were divided into two groups according to the platelet inhibition rate:AS group (n=56) and AR group (n= 34).The incidence of AR is 37.8%(34/90).2. P-selectin. The concentration of serum P-selectin in the AR group is obviously higher than that in AS group(7.80±5.87 vs 2.09±1.58, P<0.01).3. Clinical data and Biochemical index. The levels of age, fasting plasma glucose and low density lipoprotein in AR group are higher than AS group(P<0.05). There are no difference between two groups in gender, body mass index, smoking history, drinking history, hypertension history, serum total cholesterol, triglycerides, glycosylated hemoglobin and homocysteine(P>0.05).4. Multivariate logistic regression analysis. The high expression of P-selectin is the independent risk factor of AR (OR=2.780, P<0.05), in addition, fasting blood glucose and low density lipoprotein are correlated with the risk of AR.ConclusionThe expression level of serum P-selectin is closely related to AR in patients with coronary heart disease, it could be used as a new effective evaluation index for AR. In addition, the higher levels of fasting blood glucose and low density lipoprotein are independent risk factors for AR.