Correlation Analysis Of DKK2 Serum Level And The Severity Of Coronary Artery Disease In Patients With Coronary Heart Disease

Objective:Coronary atherosclerotic heart disease,also known as coronary heart disease,has gradually increased in recent years around the world.With the increase of overweight and obesity,the psychogenic death caused by coronary heart disease is increasing year by year in China.From the clinical diagnosis of coronary heart disease,its "gold standard" corresponds to percutaneous coronary angiography,and there is no obvious specific serum marker.Therefore,finding a specific serum marker is beneficial to the early diagnosis and treatment of coronary heart disease.Studies have shown that Wnt/β-catenin signal channel,which is closely related to heart development and affects atherosclerosis,plays a key role in the occurrence of coronary heart disease and participates in the pathogenesis of coronary heart disease Dickkopfs secrete egg whites,including DKK1-4,which can inhibit Wnt/β-catenin signal channel to a certain extent.Studies have shown that inhibiting DKK2 expression in vitro can activate WNT signal channel and enhance the survival of cardiac fibroblasts.DKK2 may play an important role in coronary heart disease,but the correlation between DKK2 and the degree of coronary stenosis has not been discussed.Methods:In this study,patients who were hospitalized in Qilu Hospital of Shandong University from October 2019 to October 2020 for coronary heart disease and underwent coronary angiography for the first time were divided into ischemic with non-obstructive coronary artery diseases(IOCA)group and ischemic with obstructive coronary artery diseases(IOCA)group according to CAG results.There are 39 cases in the INOCA group and 145 cases in the IOCA group.The levels of peripheral blood leukocytes,serum NT-pro BNP,fasting blood glucose,blood lipid and liver function,including fibrinogen,renal function,D-dimer,homocysteine and lipoprotein phospholipase A2,were measured respectively in the two groups.Left ventricular fraction fraction(LVEF)was evaluated by cardiac Doppler ultrasound,and DKK2 level in serum was measured by ELISA.According to the score of SYNTAX,the coronary lesions were determined:low risk group(SYNTAX score ≤22),medium risk group(22<SYNTAX score≤32)and high risk group(syntax score>32).The level of serum DKK2 and its correlation with SYNTAX score were statistically analyzed,and the clinical application value of DKK2 in the diagnosis of coronary heart disease was evaluated.Results:1,Comparison of general baseline data:age,sex,height,weight,BMI,diastolic blood pressure,systolic blood pressure,peripheral blood white blood cells,total cholesterol,serum apolipoprotein B and triglyceride,etc.,including homocysteine,fasting blood glucose,free fatty acid and creatinine,D-dimer and BUN,have no significant statistics between INOCA group and IOCA group.There were significant differences in high density lipoprotein cholesterol,serum apolipoprotein A1,lipoprotein A,cystatin C,LUEF,NT-proBNP and fibrinogen among the groups(P<0.05).2.The serum DKK2 level in IOCA group was negatively correlated with SYNTAX score(r=-0.543,P<0.001),while the serum DKK2 level in IOCA group was positively correlated with high density lipoprotein cholesterol(r=0.542,P<0.001).3.The serum DKK2 levels of the INOCA group,the low-risk group,the intermediate-risk group,and the high-risk group were:INOCA group(5.8±2.92),low-risk group(4.29±1.60),intermediate-risk group(3.47±1.10),and high-risk group(2.39±0.89).(P<0.001).4.The predictive value of DKK2 level for IOCApatients was evaluated by ROC curve.the area under the curve of DKK2 level for IOCA patients was 0.812[95%CI:0.725-0.899,P<0.001].when DKK2 level cut-off value was 4.324ng/ml,its diagnostic value was the highest,with sensitivity of 76.7%and specificity of 70.4%.5.Multivariate binary Logistic regression analysis showed that there were significant differences between DKK2 concentration and serum apolipoprotein A1,HDL-C,lipoprotein A,age,cystatin C,hypertension history(P<0.05).There is a positive correlation between lipoprotein a,cystatin c a,age,hypertension history and IOCA,and there is a negative correlation between these indexes and IOCA according to DKK2 concentration,HDL-C and serum apolipoprotein A1.6.Multivariate binary Logistic regression analysis showed that the concentration of DKK2 was related to the degree of coronary artery stenosis,and the lower the concentration of DKK2,the more severe the degree of coronary artery stenosis.When other variables were adjusted,the probability of increasing DKK2 by 1 ng/ml was EXP(-0.136)=0.873 times.Conclusion:Compared with ischemic patients with non-obstructive coronary artery disease,the serum DKK2 level in patients with obstructive coronary artery ischemia disease was lower.According to the analysis of patients with obstructive coronary ischemia,there is a correlation between serum DKK2 concentration and coronary artery disease,and this degree is negatively correlated with SYNTAX score.The results show that the lower the concentration of DKK2 itself,the more serious the coronary artery disease is.DKK2 is an independent risk factor for coronary heart disease,and the concentration of DKK2 in serum is helpful to evaluate the degree of coronary artery stenosis.