The Research About The Relationship Between Acute Coronary Syndrome And Platelet-to-Lymphocyte Ratio And Different Phenotypes Of Lymphocyte

Part1.Relationship between platelet-lymphocyte ratio and severity of coronary artery disease in patients with acute coronary syndrome Objective At present,it has been clear that inflammation and immune mechanisms are involved in the process of coronary atherosclerosis and plaque rupture,and the mechanism involves the joint participation of a variety of cells and cytokines.This study intends to explore the relationship between platelet-lymphocyte ratio and the complexity of coronary artery lesions.Methods We chose 462 patients who were hospitalized in TianJin Chest Hospital and diagnosed ACS by coronary angiography between January 2018 and June 2018.We collected medical history after admission,including gender,age,history of hypertension,diabetes,cerebrovascular disease history,smoking history,etc.At the same time patients were examined by cardiac ultrasound in the 48 hours after admission,and took 2ml peripheral venous blood after fasting 8 hours in the morning,determination of blood routine and biochemical indexes of platelet and lymphocyte ratio calculation.SYNTAX score was calculated according to the results of angiography and coronary artery lesions.Statistical software was used to analyze the results to investigate whether there was a correlation between the ratio of platelet-lymphocytes and SYNTAX score.Results 1.In the group with higher SYNTAX score,the percentage of male patients,hypertension,diabetes mellitus,history of cerebral infarction,history of myocardial infarction and multi-vessel lesions were more than the group with lower SYNTAX score,and the difference was statistically significant.Compared with the lower SYNTAX score group,the higher SYNTAX score group had more age and less LVEF,and the difference was statistically significant,which was consistent with the previous findings(P<0.05).2.Compared with the lower SYNTAX score group,blood glucose,creatinine,uric acid,low density lipoprotein,white blood cell count,platelet count and platelet-lymphocyte ratio were all increased in the higher SYNTAX score group,while lymphocyte count decreased in the higher SYNTAX score group,and the difference was statistically significant.3.Age,gender,hypertension,diabetes,previous history of myocardial infarction,history of cerebral infarction,as well as platelets,lymphocytes,PLR,white blood cells,LDL,creatinine and uric acid were significantly positive correlated with SYNTAX score in univariate analysis(P<0.05).Multivariate Logistic regression analysis was applied to include the above factors as covariates in the model.The results showed that PLR,age,diabetes,previous history of myocardial infarction,leukocyte and LDL were significantly positive correlated with SYNTAX score,which were risk factors for the complexity of coronary artery disease(P<0.05).Conclusion 1.PLR is significantly positive correlated with the severity and complexity of coronary atherosclerosis in ACS patients,and is a risk factor of high SYNTAX score.PLR can be used for the risk stratification of ACS patients,which has a certain suggestive effect on the treatment of ACS patients.2.The risk factors that have been identified at present,such as male,hypertension,diabetes,blood glucose,and low-density lipoprotein,are also higher in the patients with higher SYNTAX score than the patients with lower SYNTAX score.This is consistent with the previous findings,and confirms that gender,hypertension,diabetes,and high LDL levels are indeed risk factors for coronary heart disease and ACS.3.Compared with the lower SYNTAX score group,patients in the higher SYNTAX score group had higher white blood cell count,higher platelet count and lower lymphocyte count,suggesting that immune factors are involved in the process of coronary atherosclerosis.The specific mechanism remains to be further studied.Part2.Expression and significance of CD4~+CD45RA~+T lymphocytes and CD4~+CD45RO~+T lymphocytes in peripheral blood of patients with acute coronary syndrome Objective The purpose of this study was to compare the expression of CD4~+CD45RA~+T cells and CD4~+CD45RO~+T cells in peripheral blood of patients with acute coronary syndrome,and to explore the causes and relevant significance.Method We chose 82 patients who were diagnosed of acute coronary syndrome(ACS)and agreed to have coronary angiography examination in Tian Jin Chest Hospital during March 2018 to April 2018,including 27 cases of unstable angina pectoris(UAP),27 cases of non ST segment elevation myocardial infarction(NSTEMI),28 cases of acute ST-elevation myocardial infarction(STEMI).At the same time we chose 29 patients who were diagnosed coronary artery stenosis or no coronary artery lesion by coronary angiography examination.They were taken venous blood after admission,detection of blood routine,allergic CRP,renal function and blood lipid levels.The expressions of CD4~+CD45RA~+T cells and CD4~+CD45RO~+T cells in peripheral blood were detected by flow cytometry,and the results were analyzed by statistical software.Result 1.The number of CD4~+CD45RO~+T cells in the acute st-elevation myocardial infarction(STEMI)group was significantly lower than that the control group,unstable angina pectoris(UAP)group and non-st-elevation myocardial infarction(NSTEMI)group,and the difference was statistically significant(P<0.05).2.The percentage of lymphocytes was lower and lower in the control group,UAP group,NSTEMI group and STEMI group,with statistical significance in all groups except UAP to control group and UAP to NSTEMI group(P<0.05).3.The percentage of neutrophils was more and more in the control group,UAP group,NSTEMI group and STEMI group,with statistical significance in all groups except UAP to control group and UAP to NSTEMI group(P<0.05).4.In patients with acute coronary syndrome,the value of CD4~+CD45RA~+T in the normal CRP group was significantly higher than that in the elevated CRP group,while the white blood cell count in the normal CRP group was significantly lower than that in the elevated CRP group(P<0.05).5.Grouping according to the onset time.With the extension of the onset time,the percentage of neutrophils gradually decreased,while the percentage of lymphocytes gradually increased.The percentage of CD4~+CD45RO~+T cells was gradually increased,and there was a statistical difference between the patients with the onset within 12 hours and those with the onset later(P<0.05).6.There was no significant correlation between the percentage of CD4~+CD45RO~+T cells and the severity of coronary artery disease.Conclusion The results of this study suggest that acute coronary syndrome is closely related to the immune mechanism and is associated with both specific and non-specific immunity.In the early stage of disease,the non-specific immune system starts early,and neutrophils play a major role.As the disease progresses,the specific immune system is activated,and lymphocytes begin to participate in and play a corresponding role.Both CD4~+CD45RA~+T cells and CD4~+CD45RA~+T cells are involved in the occurrence and progression of acute coronary syndrome,and the specific mechanism remains to be further studied and confirmed.