The Study On Relationships Between Serum Leptin Levels, Insulin Resistance And Coronary Slow Flow Phenomenon

Objective : To explore the relationship between the serum leptin, insulin resistance(IR ) and coronary slow flow phenomenon(CSFP) by comparing the coronaries’TFC (Thrombolysis In Myocardial Infarction frame count, TIMI frame counts),fasting serum leptin, insulin resistance index and other clinical examination indicators of the selected cases.Methods : In this retrospective study, A total of 48 patients who undergone coronary angiography (CAG) because of chest tightness, chest pain, chest discomfort in Kunming medical University second affiliated hospital from Jun 2015 to Mar 2017 as the CSFP group was involved, the CAG showed epicardial coronary arteries with <50% stenosis but with coronary slow flow. During the same period a total of 62 patients with <50% stenosis and coronary slow evaluated by CAG was involved as the control group (NCF group). Patients’ coronary arteries’ TIMI frame count of left anterior descending branch (LAD) ,the left circumflex branch (LCX), and right coronary artery (RCA) in the CSFP group and NCF group were recorded. All patients’basic clinical data and fasting blood glucose (FBG) , fasting insulin (FINS) in the early morning, blood lipids and other clinical examination indicators was Collected.Examined the level of fasting serum leptin by the way of enzyme linked immunosorbent assay-ELISA. In the way of the HOMA model calculated the insulin resistance index - HOMA-IR all of patients selected , HOMA-IR=FBG*FINS/22.5.Analyzed the statistical differences between groups of patients’ serum leptin, HOMA-IR . mean coronary TIMI frame counts-mean TFC, and other each clinical data and each clinical examination indicator. The relevant factors related CSFP were analyzed by using person’s rank correlation or Spearman’s rank correlation analysis. Estimated the predictive value of serum leptin and HOMA-IR on CSFP by using the receiver operating characteristic - ROC curves. With using the stepwise multivariate linear regression analyzed the correlation of relevant factors.Results:1. This study found that CSFP group compared with NCF group, showing obviously significant statistical differences regarding age, smoking, sex, body mass index(BMI), FBG, FINS ,HOMA-IR, Waist to hip ratio(WHR) and Mean platelet volume(MPV) , C reactive protein(CRP) , leptin(P<0.05). And there were no significant statistical differences regarding drinking history, prevalence of hypertension, prevalence of diabetes, TC, TG, LDL-c, HDL-c, platelet count.(P>0.05)2. The serum leptin levels ,HOMA-IR of CSFP patients are obviously higher than the people of NCF group (P < 0.001). The correlation analysis among Mean TFC, serum leptin levels, HOMA-IR showed that serum leptin levels was positively correlated with Mean TFC (r=0.616, P< 0.001) and HOMA-IR was positively correlated with Mean TFC (r=0.622, P<0.001); and serum leptin levels was positively correlated with HOMA-IR(r=0.484, P=0.003).3. Receiver-operating characteristic (ROC) curve was generated for the area under the curves (AUCs) of serum leptin levels, HOMA-IR. The diagnostic value by the AUC for serum leptin and HOMA-IR in discriminating patients with CSFP was 0.972 and 0.836.4. Single vascular lesion is common in patients with CSFP in this study(60.42%,n=29),especially the right coronary artery(52.08%, n=25). The patients in the CSFP group were divided into three groups according to the number of lesion coronary artery. By comparing the serum leptin levels, HOMA-IR in each groups,there were significant differences in each group(P < 0.001).The serum leptin levels and HOMA-IR in patients with single vascular lesion were the lowest, and there were significant differences by comparing with the serum leptin levels,HOMA-IR of patients with two vascular lesions and patients with three vascular lesions(P < 0.05).There was no significant differences in the comparison of the serum leptin levels and HOMA-IR between the two-vascular-lesions group and the three-vascular-lesions group(P>0.05).5. Stepwise multivariate linear regression analyzed that leptin, HOMA-IR were isolated factors affecting mean TFC in CSFP,the equation: Y(mean TFC)=0.014X1(leptin)+0.181X2(HOMA-IR)-4.140.( X1、X2, P<0.01).Conclusions:1. The serum leptin levels, HOMA-IR in patients of CSFP group are obviously higher than the people of NCF group, Serum Leptin and insulin resistance index have some predictive value in the diagnosis of CSFP.2. The incidence of CSFP was also correlated with age, sex, smoking, FBG, FINS,BMI,WHR,MPV, CRP.3. Singly vascular lesion is common in patients with CSFP in this study, especially the right coronary artery.