The Change Of Serum CypA Level In Type2Diabetic Patients With Coronary Heart Disease And Its Relationship With Coronary Lesion

BackgroundWith the social and economic development, the incidence of coronary heartdisease was climbing during the past three decades, and it still keeps upward. Now, itis one of frequently-occurring diseases in our country, threaten severely people’shealth. The incidence of coronary heart disease in the diabetic patients was manytimes higher than the people without diabetes. Moreover, about75%diabetic patientsdied from coronary heart disease. While many studies have been carried out to theprocess of atherosclerosis, but the detailed mechanisms were remain unclear. Nowlots of researches have shown that the pathological mechanism of atherosclerosis maybe related to factors of the inflammatory responses, metabolic imbalance,immunologic derangement, etc. Cyclophilin A is a highly conserved protein, which iswidely present in prokaryotic animal, plant, bacterial, fungal.It is a member of thecyclophilin protein family, and has been called peptidylprolyl isomerase A. But itwas only identified as the special cytosolic binding protein of the immunosuppressivedrug cyclosporin A (CsA) when purified from bovine thymocytes for the first timein1984. CypA was just considered to be an intracellular protein in the past years, butrecent studies have shown that it can be secreted by cells in response to inflammatorystimuli and may have a close relationship with human disease. Now some studies have found that CypA was highly expressed in atherosclerotic plaques from ApoE/mice. So, it was speculated that cyclophilin A may be involved in thepathophysiology of atherosclerosis.And,other study found that CypA could besecreted from circulating monocytes in high glucose medium. However, studies onthe relationship between the change of CypA concentration and the severity ofcoronary artery lesion in patients with coronary heart disease and type2diabetesmellitus have not been reported.ObjectiveThis study aimed to investigate the change of serum CypA levels in type2diabetic patients with coronary heart disease and its relationship between coronarylesion.MethodNinety-eight patients were enrolled in our research,who were admitted in thedepartment of Cardiology of the First Affiliated Hospital of Zhengzhou Universityfrom January2013to June2013.All the patients were underwent coronaryangiography during the period of hospitalization. Coronary heart disease wasdiagnosed according to the Diagnostic criteria for coronary atherosclerotic heartdisease,which was was promulgated in2010by the Ministry of health, people’srepublic of china. The diagnosis of type2diabetes mellitus was based on theGuidelines for the prevention and treatment of type2diabetes Chinese2010.Theparticipants who met the conditions above were divided into3groups as follows:group A (normal control group), group B (coronary heart disease patients withoutdiabetes mellitus), group C (coronary heart disease patients with type2diabetesmellitus). Group A had29patients,15males and14females, average age (60.23±9.24) years old. Group B had38patients with coronary heart disease:21males,17females, average age (65.61±7.86) years old. Group C had31patients with coronaryheart disease and type2diabetes mellitus:17males,14females, average age (63.38±8.58) years old. Fasting plasma glucose (FPG), glycated hemoglobin (HbAlc), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDLC), highdensity lipoprotein cholesterol (HDLC) and other biochemical indicators weremeasured by the clinical laboratory testing center. The concentration of serm CypAwas detected by using enzyme-linked immunosorbent assay (Enzyme-LinkedImmunoSorbent Assay, ELISA). The severity of coronary artery lesion was evaluatedaccording to the Gensini score. Statistical analyses were performed using SPSSsoftware version17.0. Measurement data were first carried normality test.Continuousvariables are expressed as the mean±standard deviation. Categorical data arepresented as proportions. Between the two groups were compared using t test amonggroups were compared using ANOVA, the differences between the groups wasstatistically significant on the basis of further pairwise comparison t-test.The Pearsoncorrelation analysis was used to assess the relation between two quantitative variableswith normal distributions. For non-normally distributed data, a Spearman correlationanalysis was performed.A P<0.05were considered statistically significant.Results1.The concentration of serum cyclophilin A in the coronary artery diseasepatients with type2diabetes mellitus group (14.06±9.96ng/ml) and coronary heartdisease patients without diabetes group (8.48±2.23ng/ml) were apparently higherthan that of the normal control group (4.34±0.96ng/ml), the difference wasstatistically significant (P<0.01); The concentration of serum cyclophilin A in thecoronary artery disease with type2diabetes mellitus group was higher than that of thecoronary heart disease patients without diabetes, the difference was statisticallysignificant (P<0.05);2.The coronary artery disease patients with type2diabetes mellitus group had ahigher Gensini score than the coronary heart disease patients without diabetesgroup’s,the difference was statistically significant (P<0.05);the serum level of CypAin the coronary artery disease patients with type2diabetes mellitus group waspositively correlated with Gensini score(r=0.76, P <0.01);3. The levels of Fasting plasma glucose (FPG) and glycated hemoglobin (HbAlc) in the coronary artery disease patients with type2diabetes mellitus group were higherthan those of the coronary heart disease patients without diabetes group and thenormal control group, the difference was statistically significant (P<0.01); theserum level of HbA1c in the coronary artery disease patients with type2diabetesmellitus group was positively correlated with the concentration of serum cyclophilinA (r=0.45, P <0.05);Conclusion(1) The concentration of serum Cyclophilin A in the coronary artery diseasepatients with type2diabetes mellitus group was higher than that of the coronary heartdisease patients without diabetes group and the normal control group, and it waspositively correlated with the concentration of serum cyclophilin A.(2) The concentration of serum Cyclophilin A in the coronary artery diseasepatients with type2diabetes mellitus was closely related with the severity ofcoronary artery stenosis.(3) Determination of serum CypA may become a valid indicator to assess thecoronary lesions in coronary heart disease patients with type2diabetes mellitus.