| Coronary atherosclerosis is the pathologic foundation of thecoronary heart disease。Currently, selective coronary angiography(SCA)is the gold standard to evaluate the pathological changes ofcoronary atherosclerosis。Because its invasion, and only show thepathological changes of luninal and cannot reveal soft plaqueeffectively, at present time, coronary angiography is not suitable toselect different types of coronary heart disease. The high sensitiveC-reactive protein (Hs-CRP) is the marker of low level acuteinflammation of tissue; The cardiac troponin I (cTnI) is more effectivemarker to reflect the sensitivity and speciality of myocardial damage;furthermore, multislice spiral computed tomography (MSCT)perfectly display pathological changes of coronary artery cavity andwall. And it can already show both soft and hard plaque, even Hs-CRPand cTnI correlate closely with coronary heart disease, especially theacute coronary syndrome (ACS) patients. So those three factors havehigh value for diagnosis and prognosis of different types of coronaryheart disease. But at present three factors are applied in single way.Objective of this study is to investigate the value of application indifferent types of CHD and estimate the stability of atherosclerosisplaque by measuring all the factors together.Method: 60 subjects were enrolled from July 2003 to September2004. 40 patients are in our cardiology and geriatric departments and20 patients are from No.1 hospitol of dalian medical university.According to selective standards, all patients were divided into threegroups. Stable angina (SA) group: there are typical angina pectoris inpatients more than half year; electrocardiogram (ECG) shows theabnormal ST-T changes, While SCA examination manifestes at leastone vessel more than 50% stenosis. Unstable angina (UA) group: Thesufferer takes place at least quiet angina pectoris one time within 48hours before they came to hospital; During heart attack, ECG showsST-T abnormal in at least two leads, the duration of chest pain is lessthan 30 minutes, and ECG recovered after pain released; CK-MB isless than upper-limite. Acute myocardial infarction (AMI) group:According to the standards of international heart disease academicassociation and World Health Organization, based on the history ofchest pain, dynamic evolvement of electrocardiogram, CK-MB andcTnI. Three groups'patients all accepted SCA, the diagnosis of CHDbased on the stenosis of coronary artery branch is at least more than50%. There are 16 patients in SA group: 12 of males and 4 of females;24 patients in UA group: 20 of males and 4 of females.20 patients inAMI group: 15 of males and 5 females. Excluded standard: dilatedmyocardiopathy, persistent atrial fibrillation, serious valve heartdisease, infection, malignant tumor, significant dysfunction of liverand kidney, serious electrolyte disorder, hypotension and shock,recently external injury and rheumatism, rheumatoid arthritis etc. All patients were examined Hs-CRP with Becman LY-20automatic biochemical instrument made in the United States byimmunity compared method and cTnI was tested in ACS180SEautomatic immunity radiation instrument by immunity radiationmethod .Normal range of Hs-CRP is 0 -1 mg/l, and normal cTnI isless than 0.63ng/ml. Three groups'patients were checked MSCT ofcoronary imaging and SCA in two weeks. According to the diameterof coronary artery stenosis, <25% for normal, 25-50% formild,51-75% for moderate,76-99% for heavy,100% for completeobstruction. The result of MSCT coronary imaging, Hs-CRP and cTnIare Compared. Hs-CRP compares with cTnI in coronary artery branchnumber with pathological changes, stenosis degree, and differentplaque. Result: (1) the levels of Hs-CRP, cTnI in UA and AMI group arehigher than those of SA group, P<0.01, differences of Hs-CRPbetween UA and AMI groups are undetectable, P>0.05. (2) nosignificant differences are found in numbers of the coronary arterybranch among three groups, P>0.05. But there are significantdifferences between UA, AMI groups and SA group in stenosis degree,P<0.01.That is, mild and moderate stenosis in UA and AMI patientsand heavy stenosis in SA patients mainly. (3) no significantdifferences between different number of coronary artery branches inHs-CRP and cTnI, P>0.05. (4) no significant differences betweendifferent stenosis degree in Hs-CRP and cTnI in, P>0.05. (5)significant difference between different plaque in Hs-CRP can befound, P<0.05. But comparing with cTnI, no difference is found,P>0.05. (6) Compared with the positive rate of atheroscleroticplaque, MSCT coronary artery imaging group is superior to SCAgroup. There is significant difference between two groups, P<0.01.Because this study has exclude infection, and the levels of cTnI haveno difference in the soft and hard plaque, this means that increasingHs-CRP of sofe plaque group are associated with local inflammationof unstable soft plaque instead of whole body inflammation andmyocardial damage. Therefore, Hs-CRP is associated close with softplaque. Differences of Hs-CRP between UA and AMI groups areundetectable, and the levels of Hs-CRP in UA and AMI group arehigher than those of SA group, this can determine that UA and AMIhave same pathologic foundation, namely the unstable coronaryatherosclerotic plaque breaken and bleeding, then platelets congregateand produce thrombosis. But in SA there exsits stable plaque, and thiscauses moderate or heavy degree stenosis in coronary artery. cTnI isthe higher marker to reflects the sensitivity and speciality ofmyocardial damage. So increased cTnI indicates serious myocardialischemia or damage. It exsits unstable plaque in UA and AMI patients'coronary artery. With the plaque breaks, it causes small vesselobstruction and puniness myocardial damage finally, cTnI will berelease into the blood circulation .This shows that increased cTnI can...
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