The Study On Relationship Between Carotid Atherosclerosis, Endothelium Dysfunction And Serum Adiponectin In Metabolic Syndrome

BackgroundObesity, hypertension, lipid dysfunction in one patient have been found occasionally for a long time.In 1998,Reaven brought out the definition of Metabolic syndrome, It included the insulin resistance, lipid dysfunction, and hypertension, which is also called X syndrome or insulin resistance syndrome. Now not only it is related with insulin resistance and diabetes mellitus, but also it is related with endothelium dysfunction, vascular diseases caused by atherosclerosis.Research work on metabolic syndrome are brought out in detail because of the intense relationship with clinical heart and metabolic diseases.It is a cluster of many risk factors, including obesity, hypertension, dysfunction in lipid and glucose metabolisim.It is also the others ,such as hyperuricemia,fibrin and PAI-1, LDL-C, PCO, and so on.It is very important for the prevention and treatment of cardiovascular diseases to make clear the relationship between metablic syndrome and atherosclerosis. Metabolic syndrome comes together with decreasing of serum adiponectin. And adiponectin has multiple antiatherosclerosis actions, which might become in future the treatment target. The study is aim to investigate relationship among the level of serum adiponectin ,carotid atherosclerosis and endothelium dysfunction between coronary heart disaese patients with metabolic syndrome and coronary heart disaese patients without metabolic syndrome.Methods122 patients of coronary heart disease (acute coronary syndrome 87 cases,stable angina 35 cases) are included. 52 cases are diagnosed as metabolic syndrome according to the diagnostic standard of IDF. Then we collected patinets' history, had them take EKG examnation and determined serum adiponectin by ELISA.A t the same time, IMT, AIIc% and endothelium function are determined by ultrasound examination.Statistic analysis:Continuous variables are reportes as mean±deciazione standard and have been analysed by SPSS 13.0. For all analysis, a p value less than 0.05 is considered significant.Results1. ACS ocurrencing rate in coronary heart disaese patients with metabolic syndrome was higher than that in the patients without metabolic syndrome, and waist was bigger than that of those patients without metabolic syndrome (P<0.05) . The levels of TC, TG, LDL-C of coronary heart disaese patients with metabolic syndrome were higher than those of coronary heart disaese patients without metabolic syndrome (P<0.05); No difference was found in the level of HDL-C between coronary heart disaese patients without metabolic syndrome and coronary heart disaese patients with metabolic syndrome. The level of glucose coronary heart disaese patients with metabolic syndrome were higher than that of coronary heart disaese patients without metabolic syndrome (P<0.05).2. SBP in coronary heart disaese patients with metabolic syndrome was higher than that in coronary heart disaese patients without metabolic syndrome (P<0.05).3. The level of adiponectin of coronary heart disaese patients with metabolic syndrome was lower than that of coronary heart disaese patients without metabolic syndrome (P<0.05).4. The level of IMT in coronary heart disaese patients with metabolic syndrome was higher than that in coronary heart disaese patients without metabolic syndrome (P<0.05). While the level of AIIc% in coronary heart disaese patients with metabolic syndrome was lower than that in coronary heart disaese patients without metabolic syndrome. The dialation rate of inner diameter of femoral artery in coronary heart disaese patients with metabolic syndrome were smaller than those in coronary heart disaese patients without metabolic syndrome (P<0.05). 5. There was association between the level of serum adiponectin and atherosclerosis markers & risk factors. Adiponectin was positively correlated with HDL-C (R~2=0.386), ,FMD (R~2=0.269) , AIIC% (R~2=0.123) . APN was negatively correlated with TG (R~2=0.171) , LDL-C (R~2=0.396) , SBP (R~2=0.171) , waist (R~2=0.396) ,BMI (R~2=0.168) ,FPG (R~2=0.414), IMT (R~2=0.161) and BaPWV (R~2=0.264), and serum adiponectin level was determined by waist (R~2=0.091), TG (R~2=0.117) ,BMI (R~2=0.159) and IMT (R~2=0.078) (P<0.05) . Conclusion1. Coronary heart disaese patients with metabolic syndrome have a lower level of adiponectin than coronary heart disaese patients without metabolic syndrome.It suggests that the lower level of protective factor in body, which might lead to a bad prognosis.2. Coronary heart disaese patients with metabolic syndrome have a smaller FMD dialation rate of inner daimeter than coronary heart disaese patients without metabolic syndrome,which suggests the greater endothelium dysfunction.3. IMT and AD values of coronary heart disaese patients with metabolic syndrome are different to coronary heart disaese patients without metabolic syndrome .which suggests that different level of carotid atherosclerosis ,and might be a clue to overall atherosclerosis .4. There was association between the level of serum adiponectin and atherosclerosis markers & risk factors. It suggests that adiponectin is involved in the development of atherosclerosis in the patients with coronary heart diaease.5 Serum adiponectin level in patients of coronary heart disease is affected by waist, TG, BMI and IMT, especially BMI.