A Preliminary Study On Peripheral Blood Endothelial Progenitor Cells In Patients With Coronary Heart Disease After Stent Implantation

Objective:From the perspective of coronary heart disease (CHD) rehabilitation, to explore the variation of peripheral blood endothelial progenitor cells (EPCs) in CHD patients with coronary stent implantation.Methods:By using exploratory research, we enrolled 30 CHD patients with coronary stent implantation from clinic or ward of Dongzhimen hospital cardiology department during August 2015 to February 2016. We investigated their basic information, rehabilitation of CHD, risk factors and traditional Chinese medicine (TCM) syndromes, meanwhile we drew blood from peripheral vein on an empty stomach in the morning, taking CD133+/CD309+as a standard to test EPCs by flow cytometry in the key laboratory. By using SPSS20.0 data statistics and analysis, and from the perspective of CHD rehabilitation, we explored the variation of peripheral blood EPCs in CHD patients with coronary stent implantation, including the variation between different rehabilitation periods as well as the variation between different rehabilitation situations.Results:1.Basic information:We enrolled 30 CHD patients, including 19 males and 11 females, male patients with average age of 58.68 years old, women with average age of 65.09 years old, the two independent samples t-test showed that the age difference between male and female patients was statistically significant (P<0.05). Patients with a primary education were in the majority (53.3%). Most of the patients (76.6%) had CHD family history. The vast majority of the patients (93.3%) had stent implantation due to acute myocardial infarction or unstable angina, no patients chose stenting during stable angina. There were only less than 1/3 patients with complications, heart failure took the majority part (75%).2.Rehabilitation of CHD:In this study, the awareness rate of CHD rehabilitation was very low (3.3%), although all patients acknowledged that heart rehabilitation is needed after coronary stent implantation, the degree of attention to CHD rehabilitation was still low (40%). The study showed that the CHD rehabilitation situation was really bad due to the low awareness and low attention rate, although patients had high use rate (>80%) of drugs that have been evidence-proved to be benefit for CHD secondary prevention, the five CHD rehabilitation prescriptions were more likely to be performed irregularly (83.3%). We found that Chinese herbs had high acceptance rate (96.7%) among the patients, suggesting that TCM may have a bright future in CHD rehabilitation. 3.Risk factors:Hypertension, hyperlipidemia, and abnormal glucose level were the three most common combined disease of CHD. Over half of the patients (56.7%) had a history of smoking, and nearly half of them (47.1%) still did not quit smoking, with the amount of more than 10 daily. A lot of the patients (53.3%) were lack of physical activity, and large number of the patients (66.7%) were overweight or obese. The psychological stress level was high in a few patients (23.3%).4.TCM syndromes:According to the CHD TCM syndrome differentiation standard in the TCMNew Drug Clinical Research Guidelines (Trial), among the 30 patients, phlegm turbidity syndrome took the most part, followed by qi deficiency-blood stasis syndrome and blood stasis syndrome. According to the Reference Differentiation Standards of TCM Deficiency Syndrome, in viscera syndrome differentiation, heart deficiency syndrome was most common, then were the kidney deficiency syndrome and liver deficiency syndrome; in qi, blood, yin and yang syndrome differentiation, qi deficiency syndrome was mostly seen. According to the CHD TCM symptom grading standard in the TCMNew Drug Clinical Research Guidelines (Trial), in symptom score, male patients scored average 13.26 points, while female patients scored average 21.27 poinits, the two in dependent samples t-test showed that the symptom score difference between male and female patients was statistically significant (P<0.05); as in qi deficiency syndrome score, male patients scored average 6.42 points, female patients scored average 9.64 poinits, the two in dependent samples t-test showed that the qi deficiency syndrome score difference between male and female patients wasn’t statistically significant (P>0.05). According to the Coronary Heart Disease Blood Stasis Syndrome Diagnostic Criteria (Draft), all patients complied with the CHD blood stasis syndrome criteria, as in blood stasis syndrome score, male patients scored average 12.79 points, while female scored average 11.73 points, the two independent samples t-test showed that the blood stasis syndrome score difference between male and female patients wasn’t statistically significant (P>0.05).5.EPCs:The average number of EPCs in perinheral blood of the 30 CHD patients after stent implantation was 0.2697%o, while our previous research recruited 10 people who did not suffer from CHD, nor do they have the major risk factors of CHD, their average number of EPCs in peripheral blod was 0.1530%o. By two iindependent samples nonparametric rank sum test, we found that the EPCs difference between the patients and normal people was not statistically significant (P>0.05). By nonparametric rank sum test, we also found that the age and gender distribution diiference of EPCs wasn’t statistically significant neither (P>0.05). The study included 10 patients in CHD rehabilitation stage Ⅰ, their peripheral blood EPCs averaged 0.1370%o,2 patients in CHD rehabilitation stage Ⅱ, their peripheral blood EPCs averaged 0.8900%o,18 patients in CHD rehabilitation stage III, their peripheral blood EPCs averaged 0.2744%o, and through the non parametric rank sum test, we proved that the difference of peripheral blood EPCs between CHD different rehabilitation stages was statistically significant (P<0.01). Stage I patients’peripheral blood EPCs were in a relatively low level, when entered stage Ⅱ, peripheral blood EPCs surged, and in stage Ⅲ, patients’peripheral blood EPCs decreased comparing to stage Ⅱ, but were still slightly higher than stage Ⅰ. Of the 10 patients in CHD rehabilitation stage Ⅰ,2 patients carried out standard rehabilitation, their peripheral blood EPCs averaged 0.0350%o, the rest 8 patients carried out nonstandard rehabilitation, their peripheral blood EPCs averaged 0.1625%o, while the two independent samples nonparametric rank sum test showed that the difference of peripheral blood EPCs between different rehabilitation situation in stage Ⅰ was not statistically significant (P>0.05). Of the 18 patients in CHD rehabilitation stage Ⅰ,3 patients carried out standard rehabilitation, their peripheral blood EPCs averaged 0.1367%o, the rest 15 patients carried out nonstandard rehabilitation, their peripheral blood EPCs averaged 0.3020%o, and the two independent samples t’-test showed that the difference of peripheral blood EPCs between different rehabilitation situation in stage Ⅲ was statistically significant (P<0.05). The study showed that the numbers of peripheral blood EPCs in CHD patients with coronary stent implantation were moderately correlated with CHD blood stasis scores (r=0.401, P<0.05), the more severe blood stasis syndrome was, the higher the level of EPCs in peripheral blood would be. The correlation between the numbers of peripheral blood EPCs in CHD patients with coronary stent implantation and CHD qi deficiency syndrome scores hadn’t been proved (P>0.05).Conclusions:1.The variation of peripheral blood EPCs in CHD patients with coronary stent implantation has certain regularity between different CHD rehabilitation stages:stage Ⅰ patients’peripheral blood EPCs are in a relatively low level, when entered stage Ⅱ, peripheral blood EPCs surge, and in stage Ⅲ, patients’peripheral blood EPCs decrease comparing to stage Ⅱ, but are still slightly higher than stage Ⅰ.2.The numbers of peripheral blod EPCs differ in CHD rehabllitation stage III patients with different CHD rehabilitation situations, compared to nonstandard rehabilitation, standard rehabilitation has relatively low peripheral blod EPCs level.