| Objective:It's found that leukocyte differentiation antigen 40 Ligand(CD40L) and matrix metalloproteinase- 9(MMP-9) are involved in the occurrence and development of atherosclerosis(AS), which can reflect the degree of atherosclerosis and plaque stability. That new oral anticoagulants dabigatran increase the risk of myocardial infarction(MI) has been controversial, which has attracted many scholars pay more attention to the contribution of dabigatran to AS. In this study, at first we explored the relationship between CD40 L,MMP-9 and carotid atherosclerosis(CAS) degree and the stability of plaque. Then we observed the effects of dabigatran on plasma CD40 L and MMP-9 in atrial fibrillation with CAS patients, to study the possible role of dabigatran on AS in human.Methods:In this study,we selected 118 patients(average aged 65.1±10.7 years)with atrial fibrillation(67 males and 51 females) who were not treated with anticoagulant therapy lately in the cardiovascular department of our hospital during the period of December 2014 to October 2015,including atrial fibrillation with CAS 88 patients(45 cases dabigatran treatment and 43 cases warfarin treatment) and atrial fibrillation without CAS 30 patients(as control group). Preoperative examination included plasma CD40 L, MMP-9, fasting blood glucose(FBS), total cholesterol(TC),triglyceride(TG), low density lipoprotein(LDL-c), apolipoprotein A(Apo A),apolipoprotein B(Apo B), homocysteine(HCY), hepatorenal function, myocardial enzymology, echocardiography and Holter, etc. After anticoagulant therapy 3 months atrial fibrillation with CAS patients were detected plasma CD40 L and MMP-9. To analyze the changes of plasma CD40 L, MMP-9 levels in patients with different anticoagulation treatment, we explore the relationship between the amplitude of plasma CD40 L, MMP-9 levels change and the type of plaque. In statistics, two groups analysis was used for independent samples t-test, and paired t-test forcomparison pre treatment and post treatment in the group. Multiple groups were compared with single factor variance analysis. Multivariable analysis was used logistic regression analysis, and X2 test for count data. P < 0.05, indicated a statistically difference.Result:1?Compared with the control group, the results showed that the age?intima media thickness(IMT)and HCY level in atrial fibrillation with CAS group were higher than those in control group(P < 0.05), and Apo A was lower(P < 0.05) than that in the control group(P < 0.05).2?Using single factor variance to Analysis control group, stable plaque group and unstable plaque group,the results showed that the unstable plaque group plasma CD40 L, MMP-9 levels were higher than those in control group(P < 0.01) and stable plaque group were increased(P < 0.01), and stable plaque group higher than control group(P < 0.01);3?Multiariable logistic regression analysis showed that plasma CD40 L, MMP-9levels and CAS were independent associated with CAS [OR=1.16,95%CI(1.03-1.29),P=0.03]; [OR=1.28,95%CI(1.05-1.51), P=0.04];4 ? According to the different anticoagulant treatment, we divided atrial fibrillation with CAS 88 cases into dabigatran gourp and warfarin group. After 3months anticoagulation therapy, the results showed that after dabigatran treatment plasma CD40 L and MMP-9 levels lewer than before treatment(P < 0.01);5?Dabigatran treatment further divided into stable plaque group and unstable plaque group according to the character of the plaque. The results showed that pre treatment and post treatment plasma CD40 L, MMP-9 difference in the unstable plaque group bigger than stable plaque group.Conclusion:1?Plasma CD40 L, MMP-9 levels were higher in atrial fibrillation with CAS paients, and related to plaque stability;2?Dabigatran can reduce plasma CD40 L, MMP-9 levels in atrial fibrillation with CAS paients;3?The reduction degree of plasma CD40 L MMP-9 with dabigatran treatment inatrial fibrillation with CAS patients were related to the stability plaque. |
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