| Background:Coagulation system dysfunction and thrombosis play an important role in the development of coronary heart disease(CHD).Tissue factor(TF) as a promoter for exogenous coagulation way,which can cause hypercoagulability of body by starting the exogenous coagulation way,is closely associated with the development of acute coronary syndrome(ACS).Tissue factor pathway inhibitor(TFPI) is a kind of endogenous protease inhibitors,can prevent the generation of FXa by inhibiting the TF/FVIIa complex so as to regulate the start of exogenous coagulation way and prevent thrombosis.Rencently,plasma TF and TFPI as indicators reflecting the state of exogenous coagulation way received much attention.Although there are some studies about that,the roles and significance of TF and TFPI in the development of CHD are still not completely known.More and more studies revealed that inflammation played an important role in the development and prognosis of CHD.A variety of inflammatory markers have become a hot research field of CHD.In particular,interleukin-18(IL-18) and interlenkin-10(IL-10) have been concerned greatly.IL-18 as a new and more efficiency inflammatory cytoldnes plays a key role in inflammatory response and involves in development of the whole pathological process of CHD.IL-18 can not only promote the development of atherosclerosis(AS),but also make the AS unstability and cause ACS or acute myocardial infarction(AMI).IL-10 is a very important anti-inflammatory cytokines,it not only can inhibit the activity of inflammatory cells,but also can reduce the stimulation to smooth muscle cells caused by chemokines and cytokines,and it is likely to play an important role in preventing the development of CHD.Although there are some studies about that,the roles of IL-18 and IL-10 in the development of CHD are still unknown completely and need to be explored.Therefore,there are a number of pathophysiological processes in the development of CHD.Studies from varies aspects have been made.Some scholars found that there were a great deal of coagulation factors and inflammatory cytokines expressing in unstable atherosclerotic plaques.The concentration of coagulation factors and inflammatory cytokines increased in the CHD patients' blood and they changed synchronizly.However,the linkage between inflammation factors and coagulation factors is still unknown.At present,studies detecting inflammation factors and coagulation factors in CHD patients together are very few.Therefore,our study detected the plasma TF,TFPI,IL-18,IL-10 in CHD patients at the same time to investigate the change of plasma inflammation factors and coagulation factors in CHD patients and explore the relationship beteen them.Percutaneous coronary intervention(PCI) is an effective way to treat CHD.It can lead to endometrial injury and atherosclerosis plaque rupture in coronary;this will inevitably cause the changed states of clotting and inflammation.Recently, studies on both coagulation states and inflammation states after PCI are very few.The change of coagulation and inflammation states after PCI in CHD patients under being given the treatment including anticoagulant,anti-platelet,statin drug is still unknown. Therefore,the aim of our study is to investigate the coagulation and inflammatory states after PCI and the interaction between them.Objective:1.To explore change of coagulation and inflammation states in patients with CHD before and after PCI by detecting the concentrations of plasma TF,TFPI and IL-18, IL-10 in CHD patients,and to investigate the significance of TF,TFPI and IL-18, IL-10 in seriousness evaluation of CHD;2.To investigate the relationship beteen inflammation factors and coagulation factors;3.Observe the change of the concentrations of plasma TF,TFPI,IL-18 and IL-10 after PCI.Subjects and Method:1.SubjectsThe patients who were in Guangzhou General Hospital of Guangzhou Military Command from March to July in 2007 were prepared to be given CAG.Those who suffer from myocarditis,a serious heart failure,and serious liver and kidney diseases, autoimmune diseases,blood diseases,inflammation,infection,and other serious systemic diseases were excluded.2.MethodAccording to whether patients suffering from CHD or not and the style of CHD, 121 are devided into 4 groups:controls group(25 cases),acute myocardial infarction (AMI) group(33 cases),unstable angina pectoris(UAP) group(33 cases) and stable angina pectoris(SAP) group(30 cases).In addition,According to whether patients suffering from CHD or not and given CAG or PCI,121 are devided into 3 groups:PCI group(62 cases),positive control group(34 cases),negative control group (25 cases).Plasma TF,TFPI,IL-18,IL-10 were detected by enzyme-linked immunnosorbent assay(ELISA).Independent samples t-test was employed to analyze the distinction of age beteen CHD and none CHD patients,x~2-test was used to analyze the difference of the other baseline information beteen CHD and none CHD patients,One-way ANOVA analysis was used to analyze the distinction in concentrations of plasma TF,TFPI,IL-18,IL-10,IL-18/IL-10 and TF/TFPI ratio in varied style of CHD patients,repeated measurement data analysis of variance was used to analyze the change of concentrations of plasma TF,TFPI,IL-18 and IL-10 in CHD patients after PCI,Pearson correlation analysis was used to analyze the relation between TF/TFPI ratio and IL-18/L-10 ratio,Partial correlation analysis was employed to analyze the association between TF and IL-18,A probability value＜0.05 was considered statistically significant.Results:1.The concentrations of plasma TF,TFPI and TF/TFPI ratio in the patients with AMI were higher than those in the patients with UAP and SAP(P＜0.05),that in the patients with UAP were higher than those in the patients with SAP(P＜0.05);The concentrations of plasma TF,TFPI in the patients with and patients with SAP were higher than control group(P＜0.05),but the TF/TFPI ratio was no significant difference between SAP group and control group(P＞0.05);2.The concentrations of plasma IL-18,IL-18/IL-10 ratio in the patients with AMI were higher than those in the patients with UAP and SAP(P＜0.05),that in the patients with UAP were higher than those in the patients with SAP(P＜0.05);The concentrations of plasma IL-18 in the patients with and patients with SAP were higher than control group(P＜0.05),but the IL-18/IL-10 ratio was no significant difference between SAP group and control group(P＞0.05).the concentrations of plasma IL-10 in the patients with AMI were lower than those in the patients with SAP, that in AMI,UAP,and SAP group were higher than those in control group,but there there was no significant difference betwen UAP and SAP group;3.The concentrations of plasma TF were positively associated with the concentrations of plasma IL-18(r=0.752,P＜0.01);TF/TFPI ratio was also positively associated with IL-18/IL-10 ratio(r=0.423,P＜0.01).4.The concentrations of plasma TF in CHD patients after PCI and in 1d after PCI were higher than that before PCI(P＜0.05),they gradually decreased in 3d after PCI, they were lower in 7d and 30d after PCI than that before PCI(P＜0.05);The concentrations of plasma TFPI in CHD patients didn't change instantly after PCI(P＜0.05),however,they were higher in 1d and 3d after PCI than that before PCI(P＜0.05),they began to decrease 7d after PCI and were lower in 30d after PCI than that before PCI(P＜0.05).5.The concentrations of plasma IL-18 in CHD patients after PCI and in 1d after PCI were higher than that before PCI(P＜0.05),they gradually decreased in 3d after PCI(P＜0.05),they were lower in 7d and 30d after PCI than that before PCI(P＜0.05); The concentrations of plasma IL-10 in CHD patients gradually rose after PCI.Conclusions:1.The higher concentrations of plasma TF,TFPI,IL-18 were in the CHD patients and paralleled with the gravity of disease.This suggested that there were hypercoagulability activity and high inflammatory response state in CHD patients. They can be used as references in risk stratification and seriousness assessment of CHD.2.The concentrations of plasma TF were positively associated with the concentrateons of plasma IL-18 before and after PCI,such phenomenon exsit between TF/TFPI and IL-18/IL-10,either.This suggested that inflammation and coagulation system closely associate with each other.3.Under the treatment of anticoagulant,anti-platelet,statin drug,there was no influence caused by CAG in the change for plasma TF,TFPI,IL-18,IL-10 in CHD and none CHD patients.Coagulation factor and inflammatory factors increased significantly in the patients with CHD in the first three days after PCI.Plasma TF, TFPI,IL-18 began to decrease 3d after PCI,This suggested that the based drug may improve such state after PCI.
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