不稳定型心绞痛患者血浆中TM的测定及其临床意义的研究

目的：分析不稳定型心绞痛（UAP）患者血浆中血栓调节蛋白（TM）水平与冠心病危险因素及冠状动脉病变程度的关系，并观察抗凝药物对TM的影响。方法：UAP组为接受介入治疗的患者30例，冠状动脉造影阴性者30例为对照组。UAP组术后随机分两组，分别予低分子肝素（LMWH）及普通肝素（UFH）共5天。测定对照组入院后次日及UAP组介入治疗前及治疗后2、3、7天血浆中TM浓度。采用Gensini积分系统评价冠状动脉病变程度，血浆中TM水平与病变积分、病变支数及冠心病危险因素间的关系用多元相关及线性回归分析。结果：UAP组血浆中TM浓度明显高于对照组（P〈0．05）；研究对象血浆中TM水平与年龄、高血压年限、总胆固醇浓度、冠状动脉病变积分呈明显正相关。结论：UAP患者血管内皮损伤严重，TM水平在一定程度上可以反映冠状动脉粥样硬化内皮损伤的范围和程度，TM水平对评价高胆固醇及高血压对内皮的损伤有意义。

The study on detection of the plasma levels of TM in patients with unstable angina pectoris

Objective:To analyze the relations between the levels of thrombomodulin(TM) of the patients with unstable angina pectoris(UAP)and severity of coronary artery lesions and that between TM and the risk factors of coronary heart disease. In the meantime, we investigated the changes of TM induced by the anticoagulants in the patients undergoing interventional therapy.Methods:Selective coronary angiography was performed. All the 30 patients with UAP were diagnosed by coronary angiography and underwent interventional therapy. According to anticoagulants administration after operation, the patients were divided into 2 groups randomly: low molecular weight heparin (LMWH) group and unfractionated heparin (UFH) group for 5 days respectively.The control group included 30 patients with normal coronary artery.Fasting venous blood was obtained on the second day after the admission in all patients,and on the 2nd,3rd,7th day after the procedure in the UAP group.TM was measured by ELISA.Gensini scoring system was adapted to determine the coronary disease lesion degrees. Multiple correlation and linear regression were used in analyzing the relations between the levels of TM of the patients with UAP and severity of coronary artery lesions and that between TM and the risk factors.Results:The plasma level of TM was significantly higher in UAP group when compared with control group(P<0.05);Similar results were also found in single vessel disease group, double or three vessels disease group when contrasted with control group respectively, but there was no dramatic difference between the two groups. In contrast with non-hypertensive patients, the plasma levels of TM in patients with hypertension was significantly higher (P<0.05). The plasma concentrations of TM in patients undergoing coronary angiography showed markedly positive correlation to age, the duration of hypertension, total cholesterol and the scores of coronary artery lesions. The levels of TM in LMWH group on the second day after procedure decreased markedly in contrast to that of pre-procedure, but there was no change of the levels of TM in UFH group.Conclusions:The plasma levels of TM in patients with UAP increased significantly, which suggested that the endothelial injuries were severe.The plasma levels of TM were of significance in assessing the endothelial injury in patients with hypertension and hypercholesterolemia.LMWH might have the effects of improving endothelial functions and decreasing the levels of TM.