| Background: Coronary heart disease has been the universal cardiovascular disease and it has seriously harming the health of the elderly.In the recent years, the incidence of coronary heart disease was younger. Framingham and others’ studies showed that the age ≤55 years old in male and ≤65 years old in female was defined as premature coronary heart disease(PCHD). The essentialprocess of the incidence of coronary heart disease is atherosclerosis. Platelet parameters have not only penetrated through the whole process of thrombosis,have also involved in the structure and property of atherosclerotic plaque. Platelet count,mean platelet volume and mean platelet distribution width are on behalf of the function of platelet adhesion and aggregation.The active function of platelet parameters must have the participation of plasma fibrinogen.Plasma fibrinogen is the final substance of haemostatic process,which improve the extent of hypercoagulability and promote the incidence of thrombosis.Therefore,monitoring the concentration of plasma fibrinogen and platelet parameters can play a crucial role in predicting and preventing of premature coronary heart disease.Objective: To explore the changes and the relationship between platelet parameters and premature coronary heart disease. The study had compared the general biochemical profile between premature coronary heart disease group and the control group,the elderly group.The paper used logistic regression analysis to explore the relationship between plasma fibrinogen,platelet parameters and the severity of coronary artery lesions in patients with premature coronary artery disease.Seattle angina questionnaire to explore the prevention value of platelet parameters and plasma fibrinogen in patients with premature coronary heart disease.Methods:420 patients in the Department of Cardiology of the First Affiliated Hospital of Anhui Medical University with suspicious coronary heart disease were enrolled in from June 2013 to January 2015. According to the coronary heart disease diagnostic criteria of WHO and coronary angiography, those patients were divided into three groups:(1) The control group which without coronary artery lesions(n=62);(2) Premature coronary heart diseasegroup(male≤55 years old,female≤65 years old,n=244), with typical angina symptoms, myocardial enzymes and troponin can be normal or abnormal, coronary angiography showed that one more major coronary vascular diameter should have stenosis more than 50%;(3) the elderly group(male>55 years old,female>65 years old,n=114); the difference with each other was compared.According to the age, the patients were divided into 5 groups and the correlation with platelet parameters was analyzed.then,PCHD group were subdivided into single branch disease, double vessel lesions and triple vessel lesions group. Its characteristics and relationship with platelet parameters were analyzed retrospectively. Finally,Seattle angina questionnaire(SAQ) was selected to assess the physical and mental status and quality of life. The assessment was performed on patients at admission and six months after enrollment.Results:(1) Compared with the control group,the body mass index(BMI)is 24.19±2.56kg/m2 higher than 22.54±2.96kg/m2 in the control group,mean platelet volume in patients with PCHD is 13.22±2.27 f L also greater than 11.21±1.62 f L,but the platelet counts in PCHD is 182.69±50.08×109/L lower than 281.73±71.93×109/L,then the level of plasma fibrinogen in PCHD is 3.35±0.86 mmol/L higher than 2.86±0.62 mmol/L,which were statistically significant difference(P<0.05).The proportion of hypertension and diabetes,the levels of high cholesterol,white blood cell count,red blood cell count and other indicators are no significant difference.(2) Compared with the elderly group,the smoking and diabetes ratio in the PCHD group is 75.0%, 18.03% lower than 80.7%, 78.07% in the elderly group,mean platelet volume in patients with PCHD is 13.22±2.27 f L higher than 11.25±1.35 f L,but the platelet counts in PCHD is 182.69±50.08×109/L also greater than 164.03±51.99×109/L,then the level of plasma fibrinogen in PCHD is 3.35±0.86mmol/L less than 3.97±0.44 mmol/L,the cardiac function index such as LVEF and E/A ratio which display the systolic and diastolic function of heart respectively are 0.48±0.17% vs 0.59±0.06% and 0.96±0.16 vs 1.02±0.32,the difference was statistically significant. Other clinical data showed that the age, the sex,blood lipids,fasting blood glucose, the hypertension ratio have no statistical difference.(3) According to the age,patients with PCHD showed that platelet counts were reduced and mean platelet volume, mean platelet distribution width were gradually increased with the age, 60 ~ 69 years old had lower platelet counts(197.01±75.98×109/L)than other age groups,higher mean platelet volume(12.95±1.24 f L)and platelet distribution width(14.58±3.23 f L),the difference was significant(P<0.05).(4) Multivariate logistic regression analysis indicated that higher smoking ratio,BMI and plasma fibrinogen, lower platelet counts can be considered as risk factors for PCHD. By compared with single and multi-vessel coronary artery lesions groups showed that platelet parameters is closely associated with the severity of coronary artery lesions in patients with PCHD(P<0.05).(5) Compared with patients first on admission,after six months’ anti-platelet therapy was significantly increase in scores of each items and total score of SAQ(P<0.05).Conclusion:Higher smoking ratio, higher BMI, platelet parameters and FIB are independent risk factors for PCHD; then platelet parameters are closely related with the extent of coronary artery lesions(P<0.05). The level of mean platelet volume, mean platelet distribution width and plasma fibrinogen in patients with PCHD were increased, but the quantity of platelet counts were reduced, the difference was significant. In short, regularlly monitoring of platelet parameters for PCHD has a certain preventive significance. Seattle angina questionnaire showed that anti-platelet therapy can improve the prognosis of patients with coronary heart disease. |
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