The Change Of SVCAM-1in Acute Coronary Syndrome And Patients With Diabetes Mellitus Before And After The Intervention And Influence Of Tirofiban To It

Objective:To observe the change of sVCAM-1before and after PCI in ACS andwith DM patients and the affect of tirofiban to it.Methods:March2012-2012in December Cardiovascular Center at the FirstHospital of Jilin University, diagnosis of patients with acute coronarysyndrome treatment after angiography for coronary heart disease and thesuccessful implantation of drug-eluting stents (rapamycin ADM) of the70patients,40cases of ACS in patients with30cases of diabetes patientswith ACS, according to whether plus tirofiban therapy were randomlydivided into four groups: Group A(control group): ACS after surgeryunused by tirofiban (20cases);Ggroup B: ACS after surgery used bytirofiban (20cases);Group C: ACS with diabetes after surgery unused bytirofiban (15cases);Group D: ACS with diabetes after surgery used bytirofiban (15cases). Bolus dose tirofiban immediately after surgery theintravenous injection10ug/kg3minutes, and then continue to use the24-minute speed0.15ug/kg/h. Before PCI, and24hours after bloodcollection, blood samples were collected within30minutes at3000rpm/Centrifuge for15min, the supernatant plasma,-80°C to save solublevascular cell samples was measured by enzyme-linked immunosorbentassay (ELISA) adhesion molecule-1(sVCAM-1) concentration.Results:1、There were no significant differences in each group of patients interms of gender, age composition, body mass index, history ofhypertension, smoking history，blood lipids (TG, TC, LDL, HDL),liver and kidney function, implanted stent length. 2、Group A and group C patients with postoperative plasma levels ofsVCAM-1compared with significantly increased, and the differencewas statistically significant (p <0.05).3、There were no significant difference about preoperative plasmasVCAM-1levels between group B and group A；Group B after a24-hour plasma levels of sVCAM-1compared to Group A after24-hourplasma levels of sVCAM-1significantly reduced, and the differencewas statistically significant (p <0.01).4、There were no significant difference about preoperative plasmasVCAM-1levels between group D and group C；Group D after a24-hour plasma levels of sVCAM-1compared with group C,24-hourplasma sVCAM-1levels decreased, the difference was statisticallysignificant（p <0.01）.5、Group C preoperative plasma level of sVCAM-1than group A, thedifference was statistically significant (p <0.05), group C after a24-hour plasma sVCAM-1levels compared with group A after a24-hourplasma sVCAM-1levelincreased more obvious difference wasstatistically significant (p <0.05).6、ACS DM group alternate tirofiban plasma sVCAM-1level decreasewith ACS without DM group was significant difference (p <0.05)7、Postoperative application of tirofiban group, B group (ACS withoutDM patients tirofiban non-team) appears no significant bleeding(bleeding gums) four cases, including two cases of routinecoagulation APTT values measured are not out four hours will halvethe amount of tirofiban review clotting conventional APTT results returned to normal range. D appears no significant bleeding (gumbleeding, epistaxis bleeding in1case) two cases, no more severe ofthe two groups during the treatment of serious bleeding eventsoccurred. Group A and Group C no bleeding events. Experiments andno deaths during follow-up events occur. During application oftirofiban,the group B (ACS Patients PCI+tirofiban team).has4casesof no significant bleeding (bleeding gums), including two cases ofroutine coagulation could not be determined, will halve the amount oftirofiban3-4hours after reexamination conventional coagulationresults returned to normal. Group D appears no significant bleeding(gum bleeding, epistaxis bleeding in1case) two cases of group A andgroup C bleeding events. Group B and Group D had no seriousbleeding, such as intracranial, gastrointestinal and urinary tractbleeding events, and no deaths.Conclusion:1、ACS without DM and ACS merger DM patients compared with thepreoperative plasma sVCAM-1concentration was significantlyhigher, suggesting sVCAM-1may a predictor of ACS without DMand ACS Mergers DM patients after PCI appear Restenosis andcardiovascular disease events.2、ACS merger DM patients compared with ACS without DM patientshave a higher plasma concentration of sVCAM-1, suggesting thatpatients with ACS with DM may have the higher the incidence ofRestenosis and major adverse cardiovascular events.3、Tirofiban can reduce ACS without DM and ACS with DM patientsafter PCI24-hour plasma concentration levels of sVCAM-1, reducepost-PCI inflammatory response, which may improve the prognosis of patients with ACS without DM especially ACS with DM, andreduce the incidence of Restenosis and major adverse cardiovascularevents.4、Tirofiban have a good security on ACS without DM and ACS withDM patients after PCI.