The Relationship Between The Levels Of Serum ADMA, Sensitivity C-reactice Protein And Coronary Stent Restenosid In Patients With Stable Angina

Background and purposeCoronary heart disease has become the most common cause of death in the world, theincidence rate showed an increasing trend in China, the interventional treatment hasbecome an important treatment of coronary heart disease. In1977, Andreas Gruentzigapplied percutaneous transluminal coronary angioplasty to clinical treatment of coronaryartery disease for the first time, and then the PTCA in technology had been advanced byleaps and bounds, and rapidly spreading, but after six months PTCA restenosis rate had ashigh as30%-60%, this seriously limited the long-term efficacy of PTCA.In1986Sigwartet al first used metal stents in coronary artery, and then percutaneous transluminal coronarystenting is widely used in clinical, opened a new chapter in the stent in the treatment ofvascular stenosis disease. Compared with PTCA, stent reduces the incidence of restenosis,but according to statistics there are still10%to50%patients with in-stent restenosis(ISR).In recent years, with the extensive application cf drug-eluting stents and newanticoagulant drugs, the rates of coronary stent restenosis were controlled significantly, butdomestic and foreign large-scale clinical trials showed that drug-eluting stents still haveabout5%restenosis rate.Therefore, how to solve the in-stent restenosis become one ofpeople most matters of concern in percutaneous coronary intervention therapy. Coronarystent restenosis is a repair response to local vascular injury, and the multiple factors ofvascular elastic recoil, thrombosis, inflammation, matrix deposition, vascular remodeling,excessive proliferation of vascular smooth muscle cells and apoptosis reduce ment areinvolved in the pathophysiological process.Inflammatory marker sensitivity C-reactiveprotein (hs-CRP), and endogenous nitric oxide synthase (NOS) inhibitor asymmetricdimethyl arginine (ADMA) can impact the endothelial function, promoteatherosclerosis formation, and nvolve in inflammation. They gradually become the hotspot of coronary stent restenosis in recent years.In this study,we select126patients ofreadmission for coronary heart disease from march2010to february2012, who underwentcoronary artery rapamycin and its derivatives-eluting stents because of stable angina, andobserve the levels of serum ADMA, NO, sensitivity C-reactive protein in patients,investigate the relationship and mechanism of action between coronary stent restenosis andthe serum ADMA and inflammatory factors sensitivity C-reactive protein a,in order tofind a new target for preventiting clinical coronary stent restenosis.Materials and Methods1.In strict accordance with the study inclusion criteria, we select126patients ofreadmission for coronary heart disease from march2010to february2012, whounderwent coronary artery rapamycin and its derivatives-eluting stents because of acutecoronary syndromes. In this study100men, age45-77years old (average age58.27±10.15years old),26women,age50-59years old (average age59.32±9.53yearsold),a total of167stents.. According to the results of coronary arteriography andrestenosis criteria,patients were divided into two groups, one with restenosis (n=21), andthe other one without restenosis (n=105).2.Record the patient’s clinical data The clinical data of all cases must be keptdetailed notes. for example age, gender, smoking, hypertension, diabetes, totalcholesterol, triglycerides, high density lipoprotein cholesterol, low-density lipoproteincholesterol, very low density lipoprotein cholesterol, uric acid. In all cases,the situationof the first time coronary angiography and interventional treatment are detailed recorded,including the number of diseased vessels, lesion, the degree of stenosis,the length ofstenosis,the length implanted stent and residual stenosis degree,and so on.3.Specimen collection In the next morning after admission,all patients, quietrecumbent state, were acquisited fasting ulnar vein blood5ml, and then adoptOlympusAU5400automatic biochemical analyzer to determine of the blood biochemicalindices.4. Determination of the serum sensitivity C-reactive protein (hs-CRP) After takingfasting ulnar vein blood5ml and ecentrifuging, supernatant liquid are saved in-20℃totest. The enzyme-linked immunosorbent assay (ELISA) determinate the serum sensitivityC-reactive protein (hs-CRP) level.5. Determination of the serum asymmetric dimethylargi-nine (ADMA) and nitricoxide (NO) After taking fasting ulnar vein blood5ml and ecentrifuging, supernatantliquid are saved in-20℃to test.In strict accordance with the instructions, high performance liquid chromatogramphy determinate the serum asymmetric dimethylarginine(ADMA), nitrate reductase method determinate serum nitric oxide (NO).Result1.After removing coronary stent restenosis related risk factors, In group withrestenosi（s3.33±3.40）the serum sensitivity C-reactive protein was significantly higher thanthat in group without restenosis（1.15±1.08）suggesting that the inflammation involve inthe pathological process of coronary stent restenosis.2.After removing coronary stent restenosis related risk factors,compared with groupwithout restenosis, the serum ADMA levels are significantly high and the serum NOconcentrations obviously reduce in group with restenosis. The serum ADMA levels areassociated with coronary stent restenosis. The serum ADMA levels has a negativelycorrelation with serum NO concentrations. There are correlation between serum ADMAlevels and coronary stent restenosis.ConclusionInflammatory response involves in coronary stent restenosis,the incidence of coronarystent restenosis has a positive correlation with the serum ADMA levels，and has anegatively correlation with serum NO concentrations. The higher serum ADMA levels,the higher the risk of restenosis. The changes of the serum ADMA and NO levels areimportant indicators to assess coronary stent restenosis.