Plasma Fibroblast Growth Factor 21,Free Fatty Acid And Lipoprotein A Levels In Patients With Coronary Heart Disease

Objective: By analyzing the characteristics of plasma fibroblast growth factor21(FGF21),free fatty acid(FFA),lipoprotein A[Lp(a)] levels in patients with coronary heart disease(CHD),the correlation between FGF21,FFA,LP(a)levels and Ginsini score,lesion count and short-term adverse cardiovascular events(MACE)was investigated.Methods: Clinical data and plasma of 120 patients with CHD and 40 patients with coronary sclerosis who were hospitalized in the Department of Cardiology and underwent coronary angiography in our hospital from August 2019 to January 2020 were collected,and a total of 40 healthy subjects were selected as the control group.According to clinical diagnosis,120 patients were divided into two clinical types: stable angina pectoris(SAP)group(40 cases)and acute coronary syndrome(ACS)group(80cases).According to the results of coronary angiography,CHD patients were divided into <20 points(mild stenosis group),20～50 points(moderate stenosis group),>50points(severe stenosis group)and single-vessel,double-vessel and multi-vessel lesion groups.The plasma levels of FGF21,FFA,LP(A),TC,TG,HDL,LDL were determined,and the correlation between these indexes and CHD,the degree of coronary artery stenosis,and the number of lesions were compared.According to the occurrence of adverse cardiovascular events(MACE)in 6 months out of hospital,CHD patients were divided into good prognosis group and bad prognosis group.The differences in FGF21,FFA and Lp(a)levels between the two groups were compared,and the ability of indicators to predict poor prognosis was evaluated by ROC curve.Results:(1)The proportion of hypertension history in CHD group was higher than that in healthy control group(P<0.05);There were no significant differences in age,gender,BMI and smoking history between CHD group and healthy control group(P>0.05);(2)The levels of FGF21 and FFA in ACS group were higher than those in SAP group(P<0.05);(3)After adjusting for age,TG,LDL,FFA,smoking history and hypertension history,the results of Logistic regression model showed that TC,HDL,LP(a)and FGF21 were still risk factors for CHD(P<0.05);(4)The levels of FGF21 and FFA in >50 groups were all higher than that of <20 groups.The FFA level of 20～50 groups was higher than that of <20 groups,the difference was statistically significant(P<0.05).Further Pearson correlation regression showed that FGF21 level was weakly positively correlated with Gensini score(r=0.30,P<0.05).FFA level was weakly positively correlated with Gensini score(r=0.24,P<0.05).(5)The levels of FGF21 in multi-vessel and double-vessel disease groups were higher than those in single-vessel disease group.The levels of FFA and LP(a)in the multi-vessel group were higher than those in the single-vessel and double-vessel groups(P<0.05);Spearman correlation regression analysis further showed that the level of FGF21 was weakly positive correlated with the number of lesions(r=0.25,P<0.01),while the level of FFA was weakly positive correlated with the number of lesions(r=0.31,P<0.01),and the level of Lp(a)was weakly positive correlated with the number of lesions(r=0.24,P<0.05);(6)There was no significant difference in LP(a)level between different prognostic groups(P>0.05);The levels of FGF21 and FFA in the poor prognosis group were higher than those in the good prognosis group,and the differences were statistically significant(P<0.05).(7)The area under ROC curve of FFA and FGF21 for predicting poor prognosis was 0.798 and0.840,respectively,and the area under ROC curve after FFA and FGF21 were0.841.The sensitivity and specificity of FFA alone were 82.80% and 79.00%,and the optimal critical value was 0.775mmol/L.The sensitivity and specificity of FGF21 alone were 82.80% and 82.70%,and the optimal cut-off value was 620.275ng/L.When FGF21 and FFA were combined,the sensitivity and specificity were 86.20% and79.00% respectively.Conclusion: 1.The elevated levels of FGF21,FFA and LP(a)in CHD patients may be used in the auxiliary diagnosis of CHD.2.FGF21 and FFA may be potential indicators to judge clinical classification and short-term poor prognosis.3.FGF21,FFA and LP(a)may be related to the degree of coronary artery stenosis and lesion count of CHD.4.LP(a)may have nothing to do with clinical classification and short-term prognosis.