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Abstract Acute coronary syndrome (ACS), including acute myocardial infarction (AMI) and unstable angina (UA), is the most threatening and lethal form of coronary heart disease. ACS has an abrupt onset and rapid development, which may lead to fatal conditions at any time. Thus, it is never too early to detect and diagnose patients with ACS. The objective of this work was to explore the significance of the combined detection of plasma thrombus precursor protein (TpP) and serum P-selectin (Ps), in the detection and diagnosis of patients with early ACS. A total of 126 subjects were included in the study, 64 ACS patients, 30 individuals with stable angina (SA) and 32 healthy persons who were selected as the control groups. There were no differences in gender, age, ethnicity, or blood glucolipid levels among the groups. Enzyme linked immunosorbent assay (Elisa) was used to quantitatively determine the plasma levels of TpP and Ps. The levels of the two biomarkers in the case group were significantly higher than those in the control groups. Among the ACS patients, the levels of TpP and Ps were higher in AMI patients than in the UA patients. In addition, there was no significant differences in the levels of Ps between SA patients and healthy persons. In conclusion, plasma TpP and serum Ps are remarkably increased in patients with ACS. Therefore, TpP and Ps may serve as ACS indicators, and their measurement may provide a support for an early clinical identification of ACS.
Resumen El síndrome coronario agudo (SCA), que incluye el infarto agudo de miocardio (IAM) y la angina inestable (AI), es la forma más amenazante y letal de enfermedad coronaria. El SCA tiene un inicio abrupto y un desarrollo rápido, lo que puede conducir a condiciones fatales en cualquier momento. Por lo tanto, nunca es demasiado pronto para detectar y diagnosticar pacientes con SCA. El objetivo de este trabajo fue explorar la importancia de la detección combinada de la proteína precursora de trombos plasmáticos (TpP) y la selectina P sérica (Ps), en la detección y diagnóstico de pacientes con SCA precoz. Se incluyeron en el estudio un total de 126 sujetos, 64 pacientes con SCA, 30 individuos con angina estable (AE) y 32 personas sanas que fueron seleccionadas como grupos de control. No hubo diferencias en el género, la edad, el origen étnico o los niveles de glucolípidos en sangre entre los grupos. Se usó el ensayo inmunoabsorbente ligado a enzimas (Elisa) para determinar cuantitativamente los niveles plasmáticos de TpP y Ps. Los niveles de los dos biomarcadores en el grupo de casos (SCA) fueron significativamente más altos que los de los grupos de control. Entre los pacientes con SCA, los niveles de TpP y Ps fueron más altos en los pacientes con IAM que en los pacientes con AI. Además, no hubo diferencias significativas en los niveles de Ps entre pacientes con SA y personas sanas. En conclusión, la TpP plasmática y la Ps sérica están notablemente aumentadas en pacientes con SCA. Por lo tanto, TpP y Ps pueden servir como indicadores de SCA y su medición puede proporcionar un apoyo para una identificación clínica temprana de SCA.
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Objective@#To evaluate the efficacy and safety of intravascular ultrasound guidance drug-coated balloon (DCB) in percutaneous coronary intervention (PCI) of situ coronary artery lesions in patients with acute coronary syndrome (ACS), and its effect on thrombus precursor protein (TpP).@*Methods@#Seventy-eight patients with ACS in Central Hospital of Changchun City from January 2015 to January 2019 were selected, including 46 cases with unstable angina pectoris and 32 cases with acute non-ST-segment elevation myocardial infarction. The patients were divided into DCB group (38 cases) and drug-eluting stent (DES) group (40 cases) by random digits table method. Intravascular ultrasound was used to guide PCI in both groups, and DCB and DES were used respectively. Coronary angiography was performed immediately and 6 months after PCI in both groups. Minimum lumen diameter (MLD) was measured by QCA system, and the lumen loss (LLL) was calculated at 6 months after PCI. Plasma TpP before PCI, 1 and 6 months after PCI was measured by enzyme-linked immunosorbent assay (ELISA). Major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction and target lesion revascularization (TLR) were followed up 1, 3, 6 and 12 months after PCI.@*Results@#Immediately after PCI, there was no statistical difference in MLD between DCB group and DES group: (1.87 ± 0.23) mm vs. (2.16 ± 0.15) mm, P>0.05; 6 months after PCI, the LLL in DCB group was significantly smaller than that in DES group: (0.31 ± 0.28) mm vs. (0.48 ± 0.19) mm, and there was statistical difference (P<0.05). There were no significant differences in the incidences of myocardial infarction, TLR and cardiac death in DCB group (P>0.05). Before PCI and 6 months after PCI, there was no statistical difference in TpP between 2 groups (P>0.05); 1 month after PCI, the TpP in DCB group was significantly lower than that in DES group: (15.31 ± 6.13) mg/L vs. (19.46 ± 8.24) mg/L, and there was statistical difference (P<0.05).@*Conclusions@#DCB is an accurate and effective treatment for ACS patients with situ coronary artery disease under the intravascular ultrasound guidance, and it can reduce the risk of thrombosis.
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Objective To explore the changes of serum visfatin and thrombus precursor protein (TpP) levels in patients with lacunar infarction,and the relationship with carotid atherosclerotic plaque ,and to determine the values of the two factors to predict lacunar infarction .Methods Carotid atherosclerosis plaques were detected in 95 cases with lacunar infarction,including 56 cases in unstable plaque group,39 cases in stable plaque group,and another 70 healthy persons were selected as control group .Serum visfatin,high-sensitivity C reactive protein (hs-CRP), interleukin-6(IL-6) and TpP levels were measured.The carotid atherosclerotic plaque was examined by color Doppler ultrasonography.Results The levels of visfatin,hs-CRP and IL-6 in the unstable plaque group and stable plaque group were higher than those in the control group (t =10.886,9.180,11.889,4.990,5.084,9.703,all P <0.05).The levels of visfatin,hs-CRP and IL-6 in the unstable plaque group were (29.10 ±8.85)μg/L,(6.15 ± 2.78)mg/L and (5.98 ±2.66) pg /mL,respectively, which were higher than those in the stable plaque group [(21.47 ±8.39)μg/L,(4.37 ±2.09)mg/L and (4.64 ±2.03)pg/mL,t =4.222,3.385,2.652,all P <0.05]. Pearson linear correlation analysis and multiple linear stepwise regression analysis showed that serum visfatin levels were positively correlated with hs-CRP and IL-6.The TpP levels of 3h,6h and 12h after cerebral infarction in the unstable plaque group and stable plaque group were higher than those in the control group (t =17.342,21.770, 18.138,11.228,15.245,14.306,all P <0.05).The TpP levels of 3h,6h and 12h after cerebral infarction in the unstable plaque group were (18.52 ±6.43)mg/L,(25.95 ±7.98)mg/L,(18.43 ±6.10)mg/L,respectively,which were higher than those in the stable plaque group [(12.40 ±5.37) mg/L,(20.81 ±8.60) mg/L, (13.86 ± 5.04)mg/L,t =3.282,2.991,3.850,all P <0.05].Conclusion The serum levels of visfatin and TpP are highly specific,can be used as important indicators for prediction and diagnosis of lacunar infarction ,and they are related to the stability of carotid atherosclerotic plaque .
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Objective To explore the chronergy of fibrinolysin and its influence on fibrinogen ( FIB ) and thrombus precursor protein (TpP) in treatment of acute cerebral infarction (ACI). Methods The clinical trial adopted the randomized single-blind placebo-controlled design.Totally, 150 patients with ACI (onset time≤12 h) were chosen and randomly divided into experimental group A ( group A receiving treatment of fibrinolysin after 12 h onset of ACI ) , experimental group B ( group B receiving treatment of fibrinolysin after 24 h onset of ACI) and control group ( group C without fibrinolysin treatment) , 50 cases in each group.The patients in experimental group A and B received basic treatment for ACI and fibrinolysin treatment.Patients in group C were given the basic treatment for ACI and placebo.The level of FIB and TpP before and after 7 days treatment, NIHSS scores before and after 14 days treatment, BI scores before and after 90 days treatment, incidence rate of progressive cerebral infarction ( PCI ) , stroke recurrence and mortality rate of the three groups were analyzed to evaluate the clinical effect of fibrinolysin.Hepatic and renal function before and after 7 days treatment, incidence rates of haemorrhage and hypersensitiveness were analyzed to evaluate the security of fibrinolysin. Results The NIHSS score of patients in group A, B and C (4.0±1.6, 6.5±2.2 and 8.0±4.7) was declined significantly after treatment (P0.05).The FIB in group A, B and C after treatment was (2.74±0.75) g?L-1,(2.82±0.83) and (3.67±1.35) g?L-1, respectively.The level of FIB in the three groups did not decrease significantly after treatment (P>0.05).However, the level of FIB in group A and B declined significantly as compared with that in group C.The TpP in group A, B and C after treatment was (3.56±1.26) mg?L-1, (3.43±1.22) and (13.21±6.54) mg?L-1, respectively.The level of TpP in group A and group B decreased significantly after treatment (P<0.05). The level of TpP in group A and B declined even more significantly than that in group C.Fibrinolysin did neither obviously injure liver and kidney nor increase the risk of bleeding, and had low hypersensitiveness incidence rate. Conclusion Treatment with fibrinolysin within 24 h after onset of cerebra infarction benefits the patients. However, dosing after 12 h onset of ACI benefits more than dosing after 24 h.Fibrinolysin plays a role of anti-thrombosis primarily by lowering the TpP level, and its influence on fibrinogen is limited.
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Objective To explore the best safe dose of warfarin in patients with heart valve replacement.Methods One hundred patients with heart valve replacement were selected.They were divided into ≤60 kg group(47 cases) and ＞ 60 kg group(53 cases),postoperative time ≤3 months group (39 cases) and postoperative time ＞ 3 months group(61 cases),international normalized ratio(INR) ＜ 1.5 (group Ⅰ,23 cases),INR 1.5-2.5 (group Ⅱ,66 cases),INR ＞ 2.5 (group Ⅲ,11 cases).The dose of warfarin,plasma thrombus precursor protein(TpP) and D-dimer(D-D) were compared.Results The dose of warfarin was (2.90 ± 1.11) mg in ≤ 60 kg group and (2.47 ± 0.18) mg in ＞ 60 kg group,and there was significant difference between two groups (P ＜0.05).There was no significant difference in the dose of warfarin between postoperative time ≤3 months group and postoperative time ＞ 3 months group (P＞ 0.05),but there was significant difference in TpP and D-D [(6.32 ± 0.01) mg/L vs.(4.97 ± 0.81) mg/L,(879 ± 52) μ g/L vs.(151 ± 35) μ g/L] (P ＜ 0.05).The incidence of complications was 2.6％ (1/39) in postoperative time ≤3 months group,which was lower than that in postoperative time ＞ 3 months group[18.0％(11/61)],and there was significant difference between two groups (P＜ 0.05).There was significant difference in the dose of warfarin and D-D between group Ⅰ and group Ⅱ,group Ⅲ [(2.56 ±0.21) mg vs.(2.94 ±0.57),(3.07 ±0.44) mg,(793.92 ±42.73) μg/L vs.(100.96 ± 21.56),(61.08 ± 20.34) μg/L](P＜ 0.05),but there was no significant difference between group Ⅱ and group Ⅲ (P ＞0.05).There was significant difference in TpP among three groups [(8.50 ± 0.63),(5.42 ± 0.78),(3.16 ± 0.38) mg/L in group Ⅰ,Ⅱ,Ⅲ respectively] (P ＜ 0.05).Conclusion With warfarin dose and the incidence of complications,the best dosage of wadarin is (2.94 ± 0.57) mg; the optimal range of INR is 1.5-2.5.
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Objective To detect the serum thrombus precursor protein(TpP)level in the patients with diabetic microangiopathy and to investigate the relationship between the changes of TpP concentrations and the diabetic microangiopathy.Methods 136 ca-ses of diabetic microangiopathy in the endocrinology and neurology departments of our hospital from July to December 2013 were selected as the research subjects and 58 healthy individuals with physical examination were selected as the normal control group(NC group).The serum TpP,Fib,D-dimer concentrations and PT,APTT were measured.The SPSS14.0 software package was adopted to perform the statistical processing.Results (1).Serum TpP concentration in the diabetic microangiopathy group was significantly higher than that in the NC group with statistical difference(P 0.05).(2).According to whether or not complicating cerebral infarction,the diabetic microan-giopathy group was divided into two subgroups.and diabetic not merged cerebral infarction group.Serum TpP concentrations in the complicating cerebral infarction subgroup was significantly higher than that in the non-complicating cerebral infarction subgroup with statistical difference(P <0.05 ).Conclusion The serum TpP concentration in the diabetic microangiopathy is significantly higher than that in the control group,which indicating that the patient is in a hypercoagulable status the risk of thrombosis.The TpP detection may contribute to early diagnosis and timely treatment of thrombotic diseases for these patients.
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Objective To explore the values and relationship among the contents of thrombus precursor protein(TpP)and plasma D-dimer(D-D),complications after mechanical heart valve replace-ment and their correlation with international normalized ratio(INR)in anticoagulation therapy and monito-ring.Methods A total of 150 patients with mechanical heart valve replacement were enrolled.TpP,D-D, INR,other indicators and complications were compared to draw conclusions.Results There were signifi-cant differences in TpP among the groups(P<0.0083).Significant differences in D-D among the postop-erative group(100.96 ±61.56),thrombosis group(17.78 ±5.94)and control group(5.97 ±1.58)were observed(P<0.0083).Significant differences in INR among the postoperative group(1.65 ±0.34),hem-orrhage group(2.22 ±0.65)and control group(1.11 ±0.10)were observed(P<0.0083),but the effec-tiveness of INR monitoring for determining the state of thrombosis was limited to a certain extent.Conclu-sion TpP and D-D examination can facilitate monitoring after mechanical heart valve replacement,and it has a certain guiding significance for determining anticoagulation therapy and monitoring of complications after mechanical heart valve replacement.
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Objective Dynamic observation of oxidized low density lipoprotein(Ox-LDL) and thrombus precursor protein(TpP) expressed in patients with acute cerebral infarction ,and explore its clinical significance .Methods To detect the Ox-LDL and the plasma TpP level of 44 patients with acute cerebral infarction (ACI)respectively in acute stage and recovery stage ,and the healthy 30 cases (control group)by using enzyme-linked immunosorbent assay (ELISA) method ,and all the ACI cases were scored by the national institutes of health stroke scale (NIHSS) .To analyze the expression of Ox-LDL and plasma TpP in patients with ACI ,and the relationship with the NIHSS score .Results Ox-LDL and plasma TpP in patients with ACI all increased compared with the con-trol group .Ox-LDL and TpP in acute stage were significantly higher than the corresponding recovery stage and the control group , the difference was statistically significant (P0 .05) .The levels of Ox-LDL were positively correla-ted with TpP in ACI group (r=0 .521 ,P<0 .05) .Conclusion The expression of Ox-LDL and plasma TpP in ACI were increased , Ox-LDL and plasma TpP level in ACI varies with changes of clinical course ,and maybe involved in the coordination and the devel-opment process of ACI ;Plasma TpP may be relevant to the seriousness of cerebral infarction ,and may be arguably used as the measurement of ACI patient′s conditions as well as the prognosis estimation .
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Objective To investigate the predictive values of P-selectin (P-sel),thrombus precursor protein (TpP) and D-dimer (D-D) in the early diagnosis of portal vein thrombosis (PVT) in patients submitted to splenectomy (or to devascularization).Methods The clinical data of 48 patients with portal hypertension (the PVT group,n=26; and the non-PVT group,n=22) who received operation in our hospital from 2009 to 2011 were retrospectively analyzed.Detecting the P-sel,TpP and D-D levels in the two groups of patients were done on preoperative day 1 and postoperative day 1,3,5,7,14.The SPSS software was used for statistic analysis.Results There were no significant differences on the preoperative day 1 levels of P-sel,TpP and D-D in the two groups (P＞0.05).The postoperative day1 levels of the three indicators in the PVT group were significantly higher than the non-PVT group (P＜0.05).Receiver operating characteristic (ROC) curves showed the area under curve (AUC) of P-sel was largest (0.893),followed by D-D,and TpP.The combined detection of the 3 indicators was highest,with the AUC up to 0.977.Conclusions Combined detection of P-sel,D-D and TpP levels were useful in the early diagnosis of PVT after splenectomy in patients with portal hypertension.
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Objective To observe the relation between the changes of plasma TpP and D-dimer in patients with acute cerebral infarction( ACI).Methods D-dimer and thrombus precursor protein (TpP) levels in plasma of 55 cases with ACI during early phase and 25 normal healthy subjects were detected,and 24/55 cases were measured dynamically. D-dimer levels were detected by automated latex D-dimer immunoassay. Plasma TpP level was determined using a new assay,the TpP_ TM(USA),which is based on an ELISA method.Results There was significant difference(P
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Objective: To investigate the role of thrombus precursor protein (TPP) in the monitoring of anticoagulation after mechanical heart valve replacement. Methods: TPP and INR were compared between the coagulant group and control group. In the coagulant group, TPP and INR were also compared between the patients with atrial fibrillation and the patients without atrial fibrillation. The relationship between TPP levels and INR levels in 60 cases of anticoagulated patients was analyzed by linear regression. Results: It was found that the anticoagulant therapy could effectively decrease the level of TPP and increase the level of INR. In the anticoagulant group, the patients with atrial fibrillation had higher TPP level than other patients. No significant relationship was found between TPP levels and INR levels. TPP level in the patients with bleeding complications was far lower than 6 ?g/ml. Conclusion: TPP is a very valuable monitoring marker assisting INR. Patients with atrial fibrillation may require higher anticongulant intensity. INR and TPP should be tested at the same time in the patients receiving oral anticoagulation after mechanical heart valve replacement.
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BACKGROUND: The relationship between thrombosis and atherosclerosis has long been recognized. It is important to diagnose them earlier and utilize thrombolytic agents earlier in the clinical diseases associated with thrombosis and atherosclerosis. So we measured the thrombus precursor protein (TpP) in these diseases and intended to investigate the changes after heparin therapy. METHODS: TpP concentration was measured in 17 patients with acute myocardial infarction (AMI), 7 patients with unstable angina (UA), 2 patients with aortic dissection (AD), 10 patients with other chest pain, and 9 patients with cerebral infarction and 18 healthy controls. We divided AMI into two groups, early presenters (n=10) who presented to the emergency room (ER) within 6 hours and late presenters (n=7) who presented to the ER after 6 hours of the onset of chest pain. Among the patients, in 24 patients treated with unfractionated heparin, the level of TpP was measured from plasma at 8 hours after therapy. We used the microtiter plate ELISA procedure. RESULTS: TpP was significantly increased in AD (mean+/-SD; 51.21+/-8.08 microgram/mL), AMI (12.07+/-9.62 microgram/mL), early AMI (11.39+/-9.25 microgram/mL), late AMI (13.05+/-10.78 microgram/mL), cerebral infarction (7.34+/-4.67 microgram/mL), and UA (7.05+/-4.72 microgram/mL) compared with healthy controls (3.03+/-1.48 g/ mL). Abnormal concentrations of TpP were observed in 2 of 2 patients (100%) with AD, 12 of 17 patients (70.6%) with AMI, 8 of 10 patients (80.0%) with early AMI, 4 of 7 patients (57.1%) with late AMI, 5 of 9 patients (55.6%) with cerebral infarction, 3 of 7 patients (42.9%) with UA, and 2 of 10 patients (20.0%) with other chest pain. Among the 24 patients following heparin therapy, the level of TpP did not show significant decrease after heparin therapy in the group of UA and AMI with increased TpP above the upper limit of normal (n=14). CONCLUSTIONS: TpP appears to be a sensitive marker of the clinical diseases associated with thrombosis and atherosclerosis. But, TpP measurement does not allow for the accurate monitoring in the treatment with unfractionated heparin.
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Humans , Angina, Unstable , Atherosclerosis , Cerebral Infarction , Chest Pain , Emergency Service, Hospital , Enzyme-Linked Immunosorbent Assay , Fibrinolytic Agents , Heparin , Myocardial Infarction , Plasma , ThrombosisABSTRACT
BACKGROUND: We evaluated the clinical utility of TpP in the diagnosis of acute coronary syndrome and changes in the level of TpP and fibrin(ogen) degradation products after low-molecular weight heparin(LMWH) therapy. METHODS: TpP concentration was measured in 12 patients with acute myocardial infarction(AMI), 21 patients with unstable angina(UA), and 9 patients with non-cardiac chest pain and 18 healthy controls. Among them, in 11 patients treated with LMWH(6 patients with deltaparin & 5 patients with enoxaparin), the levels of TpP(American Biogenetic Sciences) and Fibrinostika(R) total degradation product(TDP), fibrinogen degradation product(FgDP) and fibrin degradation product(FbDP, Organon Teknica) was measured from plasma before treatment and at 3, 12, 15 and 24 hours after treatment. RESULTS: TpP was significantly increased in AMI(19.3+/-11.0(microgram/mL) and UA patients(16.8+/-12.4(microgram/mL) compared with the patients with non-cardiac chest pain(7.1+/-5.6(microgram/mL) and healthy controls(2.6+/-1.6(microgram/mL)(P=0.040). The TpP levels was increased in 91.7%(11/12) of AMI patients, 71.4%(15/21) of UA patients and 33.3%(3/9) of the patients with non-cardiac chest pain. TpP was decreased more significantly in enoxaparin treated group than in deltaparin group(P=0.011). No significantly different changes of plasma TDP/FgDP/FbDP levels between enoxaparin and deltaparin treatment. CONCLUSION: TpP, the precursor of thrombus, appears to be a useful index of intravascular thrombotic process. In the treatment with LMWH, enoxaparin reduced TpP more markedly than deltaparin, which may be suggestive of different anti-thrombotic effect of LMWHs on thrombotic process.