| BackgroundCoronary atherosclerotic heart disease(CHD) is a multi-etioligical factors disease,which is closely related to the development of a variety of risk factors, such as age, sex,dyslipidemia, hypertension, diabetes, obesity, smoking and so on. In recent years, the incidence and mortality of CHD have showed a rapid growth trend, causing more economical and social burden. Coronary angiography(CAG) is the “gold standard” in diagnosis of CHD, but the disadvantage is invasive and expensive.In recent years, numerous studies have demonstrated that carotid artery intima-media thickness(C-IMT) is closely related to CHD. C-IMT has been widely used as a molecular marker in predicting the vascular injury of CHD. However, due to its undesirable sensitivity and specificity, whether it can be used as an independent risk predictor of CHD remains controversial.Irisin is a newly discovered peptide hormone, regulating glucose and lipid metabolism. As a proteolytic hormone derivative of the fibronectin type III domain containing 5(FNDC5) gene, nalmely myokine. It has been demonstrated to induced by exercise and secreted by myocytes. Its main physiological function is to promot browning of white adipocytes and thermogenesis. In addition, cardiomyocytes are also one of the main tissues producing irisin apart from myocytes. Numerous studies have showed that irisin has cardioprotective effect, and plasma irisin levels were significantly decreased in patients with acute myocardial infarction(AMI). Besides, plasma irisin levels is closely related to lipid metabolism and the decline of plasma levels can been seen as a risk factor for cardiovascular disease(CVD). Our recent study demonstrated that irisin could alleviate the vascular injury in diabetics, which indicates that irisin is a potential biomarker in predicting the vascular injury of CHD. However, whether the combination of C-IMT and plasma irisin levels can improve the clinical value in diagnosis of CHD has not been eluciated.Objective1. To investigate the relationship between C-IMT and plasma irisin levels and the severity of coronary artery stenosis, and evaluate the value of C-IMT and plasma irisin levels as predictors of the severity of coronary artery in patients with CHD.2. To explore whether the combination of C-IMT and plasma irisin levels can improve the clinical value in diagnosis of CHD.Methods420 subjects, who suspected with CHD, were enrolled in this cross-sectional study in Xijing Hospital from January 2015 to December 2015. Baseline clinical data(age, gender,height, weight, smoking, hypertension, diabetes, statin drugs, lipids, liver and kidney function, cardiac function, etc) were collected. Fasting plasma irisin level was detected with ELISA method. All subjects were required to take bilateral carotid ultrasonographyby one well-trained medical ultrasound doctor. According to the results of CAG, all subjects were divided into four groups by the quartile of Gensini score and the number of coronary vascular disease. All data were analyzed with SPSS19.0 software. Normally distributed veriables were presented as mean ± SD, nonnormally distributed veriables were presented as median and interquartile rang. Frequencies were given as percentages.Comparison between groups were performed by independent samples t test and mutiple groups were performed by One-way ANOVA test for normally distributed veriables and Mann-Whitney U test for nonparametric distributions. Categorical variables were compared between groups using ?2 test. Correlation analysis was performed with Pearson assay and stepwise regression analysis for analyzing independent factors. Receiver operating characteristic(ROC) curve analysis was performed to establish the best prediction model for CHD presence. P < 0.05 was considered statistically significant.Results1. Patients with CHD had significantly higher C-IMT values than subjects who were free of CHD( 0.87 ± 0.17 vs 0.73 ± 0.08 mm, P < 0.001) and had lower plasma risin levels than that free of CHD( 4.01 ± 1.48 vs 5.46 ± 1.58 ?g / m L, P < 0.001). There were significant differences in age, gender, hypertension, dyslipidemia, obesity, TC, HDL-C,cystatin C, creatinine, LVEF, FS, pro-BNP( all P < 0.05).2. All subjects were divided into four groups by the severity of coronary artery stenosis. When according to the quartile of Gensini score, C-IMT values in four groups were( 0.71 ± 0.06) mm,( 0.83 ± 0.14) mm,( 0.84 ± 0.14) mm,( 0.93 ± 0.20) mm,plasma irisin levels were( 5.87 ± 1.24) ?g / m L,( 4.36 ± 1.58) ?g / m L,( 3.91 ± 1.36)?g / m L,( 3.72 ± 1.51) ?g / m L. When according to the number of coronary artery disease,C-IMT in four groups were( 0.73 ± 0.08) mm,( 0.78 ± 0.11) mm,( 0.89 ± 0.16) mm,( 0.92 ± 0.20) mm, plasma irisin levels were( 5.46 ± 1.58) ?g / m L,( 4.20 ± 1.62) ?g /m L,( 4.27 ± 1.47) ?g / m L,( 3.61 ± 1.31) ?g / m L. There were significant differences between groups. A stepwise increase in C-IMT values and decrease in plasma irisin levels were associated with increased severity of coronary artery stenosis.3. Pearson-related analysis revealed that C-IMT was positively correlated with Gensini score( P < 0.001) and plasma irisin levels was negatively correlated with Gensini score( P < 0.001). Besides, multiple linear stepwise regression analysis revealed that C-IMT and plasma irisin levels were independent predictors of Gensini score.4. Receiver operating characteristic curve showed that combination of C-IMT and plasma irisin levels can improve the sensitivity for the diagnosis of CHD than C-IMT or plasma irisin levels alone.Conclusion1. C-IMT and plasma irisin levels were independent risk factors for the development of CHD and were closely related with coronary artery stenosis. A stepwise increase in C-IMT values and decrease in plasma irisin levels were associated with increased severity of coronary artery stenosis.2. The combination of C-IMT and plasma irisin levels can improve the sensitivity for the diagnosis of CHD, suggesting C-IMT and plasma irisin levels might be helpful for predicting the occurrence of CHD and severity of coronary artery stenosis. |
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