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The Effects of Coronary Stent Implantation on Plasma Levels of Syndecan-4 Protein in Patients with Acute Coronary Syndrome

Author: ZhangJianXing
Tutor: OuYangPing
School: Southern Medical University,
Course: Internal Medicine
Keywords: syndecan - 4 Percutaneous coronary intervention treatment Acute coronary syndrome Inflammation
CLC: R541.4
Type: Master's thesis
Year: 2009
Downloads: 65
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Abstract

Background atherosclerosis (Atherosclerosis, AS) is one of the major diseases of harm to human health, the present study indicates that the pathogenesis of atherosclerosis is a complex, integrated, long-term process. Vascular endothelial cell dysfunction and sustained inflammatory response of atherosclerosis occurred a key factor for the development and lead to acute coronary syndrome. Acute coronary syndrome (acute coronary syndrome, ACS) coronary atherosclerotic plaque rupture or erosion secondary to complete or incomplete occlusive thrombus formation is the pathological basis of a clinical syndrome. Increasing evidence indicates that AS is excessive inflammatory response to vascular injury, a large number of inflammatory mediator in the atherosclerotic plaque. Inflammatory response in ACS unstable plaques, plays a vital role in the evolution and rupture process. Coronary artery stenting (coronary stent implantation, CSI) is an effective method for the treatment of acute coronary syndrome, it can quickly restore coronary blood flow, and rescue the dying heart, but the restenosis rate as high as 20% to 30 %. Seriously affect the long-term prognosis of patients. Coronary stent substance as an allogeneic stimulation and surgery on the vessel wall caused by intimal injury, coronary plaque rupture, leading to platelet and inflammatory cell accumulation, infiltration, release of inflammatory mediators, chemokines, adhesion factors and growth factor promotes vascular smooth muscle cells (SMC) and adventitial fibroblast migration and proliferation, leading to in-stent restenosis. Therefore, stent implantation postoperative inflammatory reaction is an important cause of in-stent restenosis. Syndecan-4 protein heparan sulfate (heparan sulfate proteoglycan syndecans family of HS) transmembrane transport a member of the. It consists of four independent genes encoding Ⅰ type having a tissue-specific distribution of integral membrane proteins, the molecular weight of about 24kDa, with the 197 amino acid sequence, it consists of a long branch glycosaminoglycan (Glycosaminoglycan GAG) chains connection with the core protein via a covalent bond. GAG chains of heparan sulfate (Heparan sulfate type, HS), it is the this HS structure involved in the regulation of Syndecan-4 molecule with a ligand binding activity. The current study has shown that, Syndecan-4 regulates a variety of biological effects, is formed in the surface of the cell signal transduction system and control the behavior of cells (such as: mechanical support for the cells, adhesion, movement, proliferation, differentiation, and morphology) play an important role. Vascular syndecan-4 features include: to maintain the integrity of the vascular viscoelasticity, permeability and vascular wall to prevent the loss of the vessel contents and infiltration of the vascular wall. Tissue injury in acute and late regulate a variety of inflammatory mediators, plays an important role as a co-receptor. Syndecan-4 with normal T cell expressed and secreted regulatory factors, and stromal cell-derived factor -1 (stromal cell-derived factor-1) combined affect the aggregation of neutrophils. The relationship between coronary stent implantation and syndecan-4 protein has not been reported. In this study were used to detect coronary artery stenting with acute coronary syndrome patients before, after 1h, 24h after plasma syndecan-4 protein concentration to learn more about plasma Syndecan-4 protein concentration in the coronary arteries intervention before and after treatment. Objective To observe the coronary stent implantation for acute coronary syndrome patients with plasma Syndecan-4 protein level. Research objects and methods, from October 2007 to October 2008 Nanfang Hospital of admission by coronary angiography parallel coronary stent implantation in some patients diagnosed with acute coronary syndrome, 43 cases , except for the following cases: ① patients with severe sepsis with severe liver and kidney dysfunction; (2); (3) patients with malignant tumors; (4) the systemic immune system disease, connective tissue diseases; (5) a variety of systemic inflammatory disease; ⑥ rheumatic heart disease, cardiomyopathy, myocarditis, congenital heart disease, a history of stroke; (7) the past six months, nearly three months of trauma, infection and surgical history; the ⑧ angiography were selected cardiac function NY grading grade II or less. In the preoperative, postoperative 1h and 24h after surgery to collect venous blood samples of patients and the control group for the same period inpatient excluded by coronary angiography and coronary heart disease in some patients, were determined by ELISA the syndecan-in the two groups of patients with 4 protein levels. Collect clinical data of 43 cases of coronary stent implantation patients and 11 control patients (age, gender, smoking, alcohol consumption, blood pressure, blood sugar, blood lipids, left ventricular ejection fraction (LVEF), C-reactive protein (CRP), drug treatment, etc.), and to compare the situation. Results and statistical analysis: All values ??are expressed as mean ± standard deviation, measurement data were compared with clinical data in the CSI group and the control group two independent samples t-test to compare the rate of two samples with x ~ 2 test, CSI continuous variable data within the group and control group compared with repeated measures analysis of variance, the CSI group with the control group compared with the same point in time two independent samples t-test, P <0.05 was considered significant. Using SPSS 13.0 software package was used for statistical analysis. Results 1, the control group and acute coronary syndrome clinical data for age, gender, smoking, blood pressure, blood sugar and blood lipids, LVEF compare. The statistical analysis showed no significant difference (P> 0.05). CRP inflammatory markers Both groups had significant difference (P <0.05) reflects the inflammatory response in acute coronary comprehensive levy may play an important role. Coronary stent implant group at different time points plasma Syndecan-4 protein levels were statistically significant differences (P <0.05). After 1h plasma Syndecan-4 protein levels and preoperative significantly increased (P = 0.004) after 24h plasma Syndecan-4 protein levels and postoperative 1h and preoperative comparison were significantly lower (P = 0.000, P = 0.026 ). Three time points of the stenting group plasma Syndecan-4 protein levels were increased and then decreased trend. Stent implantation in patients with acute coronary syndrome plasma Syndecan-4 protein levels have a significant effect. Between the control group at different time points were not significantly different (P> 0.05). That simple coronary angiography had no significant effect on plasma Syndecan-4 protein levels. 3, the same time point between the two groups after stenting group the the 1h plasma Syndecan-4 protein level was significantly higher than that in the control group (P = 0.023). Preoperative and 24h after the two-point-in-time two sets of syndecan-4 protein levels showed no significant (P> 0.05). Conclusion This study found that coronary stenting can significantly increase the acute coronary syndrome syndecan-4 protein levels in the plasma of patients after 1h, 24h after plasma syndecan-4 protein levels decreased significantly. Tip syndecan-4 protein as a biological regulatory factors play an important role in acute vascular repair of mechanical damage and early vascular inflammation.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Coronary arteries ( atherosclerosis ),heart disease (CHD)
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