| Background:Acute coronary syndrome (ACS) is one kind of regular diseases and main death reasons in elders. The patients with ACS commonly presents a lot of nonclassical symptoms. To early diagnose ACS is essential to reduce mortality of elder patients with ACS. ACS related with thrombus formation in coronary. The initiation of thrombus formation is predominantly caused by rupture of atherosclerotic plaque which incurs tissue factor route of coagulation. Tissue factor (TF) and tissue factor pathway inhibitor-2 (TFPI-2) play a vital role in rupture of atherosclerotic plaque, matrix degradation, reformation, proliferation of vascular smooth muscle cells. It was not clear that whether TF and TFPI-2 could be diagnosed in ACS. Objective:To investigate the levels of plasma tissue factor and tissue factor pathway inhibitor-2 in elder patients with ACS and support the early diagnose in future.Methods:Total 176 elder cases data were analyzed. The study group was comprised of 146 elder patients with coronary artery disease (CAD), which came to the cardiovascular departments of Huashan and Huadong hospital between March 2008 and March 2009, and 30 normal healthy elder volunteers served as control group. After their subscription to the informed consent, they were arranged into the ACS group and control group. Blood samples were taken within 24 hours of symptom onset. Levels of TF and TFPI-2 were measured by enzyme-linked immunosorbent assay technique (ELISA). We set up a database by Excel 2003 and analyse the date by SPSS 15.0.Results:K A total of 176 patients were included. Female was 40.3%and male was 59.7%. Ratio of Male to female was about 1.5:1. The mean age of total patients were 72.18+7.22 years old. The patients with hypertension were 51.7%. The patients with Diabetes were 21.1%. Smokers in male were 61.0%, whereas none in female.2^ The plasma concentrations of TF in acute myocardial infarction (AMI) and unstable angina pectoris (UAP) groups were significantly higher than those in stable angina pectoris (SAP) and the healthy control groups (P<0. 05). The concentrations of TFPI-2 in SAP and the healthy control group were significantly higher than those in AMI and UAP groups (P<0.05). There were no statistical differences of TF and TFPI-2 in patients with SAP compared with those of control groups (P>0.05). The concentrations of TF in UAP group were significantly higher than those in SAP and the control groups (P<0.05). The concentrations of TFPI-2 in SAP and the healthy control groups were significantly higher than those in UAP group (P<0.05). The levels of TFPI-2 in UAP group were significantly higher than those in AMI group (P<0.05). The TF/TFPI-2 ratioes in control group were significantly lower than those in ACS group.3n The plasma levels of TF (r=0.791, P<0.001) had positive correlation with ACS. Diabetes (r=0.172, P=0.008)、smoking (r=0.212, P<0.01) and plasma level of LDL-C (r=0.341, P<0.05) would influence the plasma level of TF compared with other risk factors, such as ratio of male to female, hypertension with use of Logistic stepwise regression model. A negative correlation was observed between hsCRP and TFPI-2 plasma concentrations (r=-0.278, P<0.01).In this study, ACS was mainly owed low plasma levels of TFPI-2、LVEF、hsCRP.Conclusion:The results of this study showed that the plasma level of TF had significantly increased and TFPI-2 had significantly decrease with onset of ACS in elders. The plasma level of TF in elder ACS patients might decrease gradually with stable disease. The imbalance of ratio of plasma level of TF to TFPI-2 in elder ACS patients suggested that the plasma level of TFPI-2 is insufficient to inhibit the pathogenesis of coagulation. It indicated that TF、TFPI-2 and ratio TF to TFPI-2 might serve as important plasma indicators in early diagnosis of ACS. |
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