The Pathogenesis And Intervention Measures On Platelet Activation In Acute Coronary Syndrome Complicated With Anxiety Disorder

ObjectiveTo analyze the clinical characteristics of patients with acute coronary syndrome?ACS?with anxiety disorders and to explore the possible mechanisms of platelet activation and activation release related substances in the pathogenesis of acute coronary syndrome with anxiety disorder,and to evaluate the traditional anti atherosclerosis and sertraline drug treatment.MethodThe patients with acute coronary syndrome diagnosed in Department of cardiology from Shaanxi People's Hospital from May 2017 to January 2018 were collected.The Hamilton Anxiety Scale?HAMA?was used to evaluate the patients.The patients with scores of more than 14 scores were diagnosed as anxiety disorder.According to the results of HAMA score,the patients were divided into ACS combined anxiety group and simple ACS group.91 cases of ACS combined anxiety group and 100 cases of ACS group were included,and 89 patients with anxiety disorder were selected as simple anxiety.Group B,100 cases without basic diseases in the physical examination department were selected as the normal group.Among them,ACS combined anxiety group and simple anxiety group were given sertraline to treat anxiety.All admission data?sex,age,body mass index,biochemical indicators,history and medication history?were recorded.Blood samples were taken from the hospital the next day.Platelet activation was assessed by flow cytometry.5-HT,BDNF and NPY were measured by ELASE.After January,patients in each group were followed up,and the HAMA scale was repeated.Result1.Comparison of general conditions:?1?ACS combined anxiety disorder group and simple anxiety group:the proportion of female patients,BMI,TC,LDL-C,glycated hemoglobin,EF value,unstable angina pectoris ratio in the group of ACS anxiety disorder were higher than those in the simple ACS group.The factors of the left ventricular systolic/diastolic diameter,GRACE score,and the number of interventional treatment were lower than those in the simple ACS group.There were statistical significance?P<0.05?.?2?Simple anxiety disorder group and normal group:the proportion of female patients in simple anxiety group,TC and LDL-C were higher than those of normal group,the difference was statistically significant?P<0.05?.2.The proportion of female patients,TC and LDL-C in positive control group were higher than those in negative control group,the difference was statistically significant?P<0.05?.2.Platelet activation?1?The degree of platelet activation was higher in anxiety patients:?1?the positive expression rate of PAC-1 and CD62P in the ACS combined anxiety group was higher than that in the ACS group,and the difference was statistically significant?P<0.05?.?2?the positive expression rate of PAC-1 and CD62P in the simple anxiety group was higher than that in the normal group?P<0.05?.?2?Platelet activation before treatment of different types of ACS:the expression rate of PAC-1 and CD62P in ACS combined with anxiety group or in simple ACS group of unstable angina pectoris was lower than that in myocardial infarction group,but the difference was not statistically significant?P>0.05?.?3?Compared with patients with simple ACS,the incidence of focal platelet activation decreased significantly after giving sertraline anti anxiety treatment in ACS combined anxiety disorder group.?1?the expression rate of PAC-1 and CD62P in ACS combined anxiety group and simple ACS group was significantly lower than before treatment?P<0.05?.?2?after treatment,the expression rate of PAC-1 and CD62P in ACS and anxiety group was higher than that in simple ACS group,but the difference was not statistically significant?P>0.05?.3.5-HT,NPY,BDNF level results:?1?The plasma levels of 5-HT,NPY and BDNF in patients with anxiety were higher:?1?the level of 5-HT,NPY and BDNF in the group of ACS combined anxiety before treatment was higher than that in the ACS group,and the difference was statistically significant?P<0.05?.?2?the levels of 5-HT,NPY and BDNF in the simple anxiety group were higher than those in the normal group?P<0.05?,and the difference was statistically significant?P<0.05?.?2?The decrease of plasma 5-HT,NPY and BDNF after Seculin treatment:?1?the plasma 5-HT,BDNF and NPY in ACS combined anxiety group,simple ACS group and simple anxiety group decreased compared with before treatment,the difference was statistically significant?P<0.05?.?2?after treatment,the expression rate of 5-HT,BDNF and NPY in the ACS combined anxiety group was higher than that in the simple ACS group after treatment,but the difference was not statistically significant?P>0.05?.?3?Plasma levels of 5-HT,NPY and BDNF were positively correlated with platelet activation?r=0.304,P=0.00?.?3?There was a positive correlation between plasma 5-HT level and platelet activation markers PAC-1 and CD62P?r₁=0.306,p₁=<0.001;r₂=0.421,p₂=<0.001?.There was a positive correlation between plasma NPY level and platelet activation markers PAC-1 and CD62P?r₁=0.186,p₁=<0.001;r₂=0.233,p₂=<0.001?.There was a positive correlation between plasma BDNF level and platelet activation markers PAC-1 and CD62P?r₁=0.257,p₁=<0.001;r₂=0.134,p₂=<0.001?.4.HAMA score was positively correlated with platelet activation markers PAC-1 and CD62P?r₁=0.257,p₁=<0.001;r₂=0.134,p₂=<0.001?.ConclusionCombined anxiety disorder patients with ACS have higher platelet activation,which may require more intensive antiplatelet therapy.After the traditional antiplatelet drugs combined with SSRIs,platelet activation and related substances decreased significantly.The new combination regimen may be a therapeutic method for the treatment of ACS combined with anxiety disorders.