Relationship Between CTRP3 Levels With Coronary Lesion Severity And Coronary Collateral Circulation Formation In Patients Of Cronary Artery Heart Disease

Objective:Coronary artery heart disease, CHD, refers to the coronary stenosis or insufficiency caused by insufficient blood supply and caused myocardial ischemia and hypoxia, dysfunction and the severity of coronary artery atherosclerosis or spasm(or) implement qualitative sex pathological change is the most common thing. Coronary heart disease is one of the diseases with the highest mortality world-wide, The United States National Center for health statistics show that in 1988 the United States announced in 1987 the death toll and the death causes data,heart disease accounted for 35% of total death, including coronary heart disease deaths accounted for 24.1%, ranking to the first of the death.Acute coronary syndrome( ACS) is a group of acute myocardial ischemia caused by the clinical syndrome,Including acute myocardial infarction(AMI) and unstable angina(UA),and AMI is divided into ST-segment elevation myocardial infarction(STEMI) and non-ST-segment elevation myocardial infarction(NSTEMI).As is known to all, the occurrence and development of ACS is closely related with hypertension, hyperlipidemia, hyperviscosity, diabetes, endocrine dysfunction and age, smoking, obesity, sedentary and so on, lipid metabolism disorder is the most important predictor of coronary heart disease.Treatment of acute coronary syndrome is divided into drug treatment, interventional therapy and surgery, and percutaneous coronary interention(PCI) for its significant characteristics of small trauma, high safety, rapid recovery, shorter hospitalization time become one of the most important way for the treatment of coronary heart disease.In the recent 20 years the rapid development of interventional treatment, reperfusion measures to improve makes AMI mortality decreased significantly, but the incidence of heart failure after AMI rate increased year by year, the 5-year survival rate is only 30% ~ 70%. As for the presence of multivessel coronary artery disease and diffusein in patients, interventional therapy is more complex, and postoperative coronary artery restenosis risk is high,these patients of myocardial ischemia parts insufficient blood supply, the treated with interventional therapy and existing drugs were difficult to obtain significant results. Therefore, look for economical, efficient, good compliance assessment and adjuvant therapy to become a problem need to solve in the new century.Studies have demonstrated that patients with adequate collateral circulation in coronary arteries(CCC) small probability of occurrence of myocardial infarction, even in the event of myocardial infarction, infarct size was also worse than the collateral circulation in patients with much smaller. Timely and extensive coronary collateral circulation establishment can effectively reduce mortality and improve prognosis. Acute coronary syndrome patients undergoing coronary angiography found:the degree of coronary artery lesions in the same patients there are big differences between the degree of the development of collateral, so the study of the formation and development of collateral circulation is important.CTRP3 is a newly discovered adipokines witch is highly homologous with adiponectin. CTRP3 is composed of 246 amino acid sequence of proteins, the molecular weight of 26 kda, secretion by the signal peptide, collagen structure and C the globular structure domains.It is founded in humans and rats, also known as CORS – 26, Cartonectin and CIATNF3. The study found that CTRP3 plays an positive role in the body, it plays an important role in the regulation of metabolism, myocardial protection, promotion of angiogenesis and other aspects.Whether CTRP3 formed with coronary artery disease in patients with acute coronary syndrome severity and associated collateral circulation at the same time, yet it is currently unknown. This study was to observe the CTRP3 expression level in patients with CHD in the serum, and analyze the relationship between the severity of coronary artery disease and collateral circulation, and to explore the possible mechanism of formation of collateral circulation,so as to find new therapeutic targets for the treatment of coronary heart disease.Methods:1 According to the American college of cardiology and the American heart association 2007 revision of the diagnosis and treatment guidelines, selected 133 cases of ACS patients from January, 2014 to October,2014 at the Second Hospital of Hebei Medical University,and diagnosed by coronary angiography that at least one of the coronary meet major blood vessels(left main, left anterior descending, left circumflex artery, right coronary artery) stenosis> 50% of the 133 cases of patients. We respectively record the patients’ clinical data, such as age, sex, height, weight, body mass index and laboratory test results.2 Extract the patients’ vein blood before 8 hours of fasting venous blood, using ELISA method for the determination of CTRP3 level.3 SYNTAX score and Rentrop scoreOn the basis of SYNTAX score evaluation of coronary artery lesion severity, and according to the results,the ACS patients divided into SYNTAX mild lesion group(n = 36), the SYNTAX moderate lesion group(n = 56) and SYNTAX severe lesion group(n = 41). According to Rentrop grade method to observe the collateral formation, there are 71 cases that at least one of the coronary meet major blood vessels(left main, left anterior descending, left circumflex artery, right coronary artery) stenosis> 50% in the 133 cases of Patients. Accord to the method of Rentrop, we scale the coronary collateral circulation, we divided them into level 0(n = 17), 1(n = 14), grade 2(n = 21), 3(n = 19), the higher the score, the more abundant collateral circulation.The level 0, 1 is set to poor collateral circulation group(n = 31), and the level 2, 3 is set to good collateral circulation group(n = 40).Statistical analysis of data using SPSS 21.0 statistical software. Continuous variables are expressed in(mean±standard deviation). Normal distribution are tested with Kolmolgoro2 smirnovtest. The differences between groups were analyzed by SNK multivariate analysis of variance comparison. Correlation analysis of bivariate correlation analysis use the method of Spearman.Correlation analysis uses multiple linear regression analysis. Two-tailed P<0.05 was considered statistically significant. Through the test of variance, regression analysis and other methods to explore the relationship between CTRP3 level with the severity of coronary artery lesions and the collateral circulation.Results:1 In patients with ACS group, CTRP3 levels in severe coronary artery disease group were significantly lower than coronary intermediate lesion group and mild coronary artery lesions(P<0.01), CTRP3 levels in intermediate lesion group were significantly lower than mild coronary artery lesions(P < 0.01); CTRP3 level and severity of coronary artery disease was negatively correlated(r =-0.712, P <0.01).2 In patients with ACS group, CTRP3 levels in Poorer groups of coronary collateral circulation is significantly lower than that better group of coronary collateral circulation(P<0.01); CTRP3 levels and coronary collateral circulation formation were positively correlated(r = 0.746, P < 0.01).Conclusion:Serum level of CTRP3 is influenced by the severity of coronary artery lesions, the higher the extent of coronary stenosis, patients serum CTRP3 expression level is lower, CTRP3 expression and severity of coronary artery disease was negatively correlated; coronary collateral circulation in case the same effect on serum CTRP3 level, the richer of the coronary collateral circulation, the higher of the level CTRP3, CTRP3 expression levels and coronary collateral circulation were positively correlated.