| ACS is a kind of cardiovascular emergencies which is common in clinical, its harm is great, the main pathological changes are that of coronary atheros-clerosis and plaque rupture, thrombosis, which resulting in such clinical cardio-vascular events of myocardial ischemia or local necrosis, among which the endothelial dysfunction is the key step for occurrence of endothelial dysfunction Atherosclerosis. The endothelial system can not only selectivity prevents the mutual material exchange between blood and tissue, but also the body's largest endocrine, paracrine organ, and can secret several kinds of active substances, Such as:endothelin, Nitric oxide, prostacyclin and hyperpolarizing factor, thromboxane and so on. The normal endothelial function should at least have such functions as following:①Regulating the vasomotion, maintaining blood vessels with a certain tension;②To prevent platelet aggregation and thrombosis;③Regulating the growth and proliferation of smooth muscle cell;④To prevent infiltration of inflammatory cell and penetration of harmful substances. Normal endothelial function is to ensure the flowing of normal blood, and to prevent the formation of atherosclerosis. When with the coronary atherosclerosis, the platelet count in the stenotic blood vessels is increasing, due to loss of endothelium, platelet adhesion and aggregation and the releasing of serotonin, etc., with the reducing of synthesis of prostacyclin in atherosclerotic wall, then there are strong vasoconstriction to make the increasing of thromboxane while the prostacyclin with the effect of vasodilator is reducing, both of which are out of balance, causing coronary artery spasm. Therefore, to improve the endothelial function is become one of the important measures in the treatment of ACS.Since 2004 the rhBNP has applied in clinical, once provide the treatment of heart failure for a new way, which attracted wide attention of clinicians. Now update study shows that there is close relationship between rhBNP and ACS, and can be used for the treatment of ACS. rhBNP had the function of balancing the arteriovenous vasodilatation, and can quickly correct hemodynamic disorders, moderate diuresis natriuresis, antiover activation of the neuroendocrine system and antiheart remodeling, thus fully protecting the cardiovascular system. Clinically, our patients with ACS plus rhBNP treatment, patients, pathogenetic condition can be markedly improved, in addition to the abovementioned mechanisms, whether it has affection with the improvement of endothelial function in patients, is the hotspot for future research. As the time of the drug used for clinical treatment of ACS is short, the pertinent literature is less, hoping that through our subtile power, to study and research as much as possible of the effectiveness and safety of ACS using rhBNP for the treatment in clinical, and attempt to explore the mechanism of the drug played during the treatment, to further identify the perspective of the rhBNP.Purposes:To evaluate rhBNP therapy on endothelial function in patients with ACS, for further identify the mechanism of rhBNP in the treatment of ACS, so as to provide scientific theory for the clinical treatment of patients with ACS.Methods:44 patients with ACS, and randomly divided into experimental group of 30 patients and control group in 14 cases.14 cases of control group with conventional therapy,30 cases of test group was treated on the basis of conventional therapy plus rhBNP treatment for 3-5 days, the two groups before treatment and one week after treatment, to cull venous blood, and centrifugalize the serum, with cryopreservation deposit. After the collection of all the specimens, giving unified detection. Using enzyme-linked immunosorbent (ELISA) method to detect the content of nitric oxide (NO) and endothelin-1 (ET-1) levels in serum of each group before and after the treatment,and at the same times determinate the routine laboratory tests (blood triglyceride, cholesterol, etc.). The comparison of basic clinical data between the two groups to useχ2test, the comparisons of each groups before and after treatment were using paired sample mean test, the determination of the curative effect using the two independent sample means of t-test for statistical analysis.Results:1) The general information on the two groups showed no significant statistical difference (P> 0.05); 2) The routine laboratory examination on the two groups showed no significant statistical difference (P>0.05); 3) For the patients of experimental group, after plus using of rhBNP the content of Nitric oxide in serum was significantly increased (P<0.05), the content of ET-1 was decreased (P＜0.05), with statistical significance. For the control group before and after treatment in patients, the content of Nitric oxide and ET-1 levels in serum without significant changes (P> 0.05), no statistical significance.4) The content difference of the content of Nitric oxide and ET-1 levels in serum before and after treatment in patients is that, the experimental group changed significantly more than the control group(P<0.05), and the curative effect of the experimental group is more effective than the control group.Conclusions:Through increasing the content of Nitric oxide in the blood and reducing the ET-1 levels, rhBNP can improve endothelial function in patients with ACS, thereby improving coronary blood supply, which is one of the mechanisms of its treatment of ACS patients, thus provide a theoretical basis for further treatment of patients with ACS. |
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