Research On The Association Between Multi-noninvasive Indexes And Coronary Atherosclerosis

Atherosclerotic disease has become a serious threat to humanity.The released medical statistics from the Ministry of Health show that there are more than 150 million people suffering from cardiovascular disease in China each year,the number of the people who die of cardiovascular disease with more than 4 million,accounting for 50%of China's toll death,24%of the world's heart vascular disease mortality, furthermore,the number still on the rise.However,about 75%of patients who survive lost the ability to work to varying degrees,the majority of patients have psychological barriers which may impact on the quality of life.What is even more worrying is that more and more young people suffering from cardiovascular disease in our country.At present,the cost using for cardiovascular disease is about tens of billions of dollars,which bring a heavy financial burden to the state and the family. Therefore,early detection and prevention of cardiovascular events become more and more important,It is useful to reduce the incidence,disability and mortality rates of cardiovascular disease.Atherosclerosis is a systemic vascular lesions,such as coronary heart disease, which is the performance of the irreversible stage during development of the vascular atherosclerosis.Study shows that the development of vascular disease is a long process,Under the various risk factors,from the initial impaired arterial endothelial function,the increases in arterial stiffness,the lipid stripes visible in the arterial wall,the formation of atherosclerotic plaque and vascular remodeling,to vascular stenosis or a complete occlusion of lumen caused by plaque rupturing or the formation of thrombus,which lead to cardiovascular events happened around a few years or even decades.So it is a good opportunity to detect and interve the progress of coronary heart disease early.It means that we have the opportunity to detect coronary artery disease early,through a systematic and convenient evaluation techniques,to screening high-risk groups in coronary heart disease in order to interven timely by taking corresponding measures.It is regrettable that assessment on the early of vascular disease by systematic methods is lack at present,Although invasive vascular interventional technology has become the most direct and accurate method in vascular disease diagnosis and treatment,but there is limited because of its invasive,lagging and very costly,and inconvenient for repetitive follow-up and observation.Thus the critical way to reduce incidence of mortality and disability of clinical cardiovascular events is to carry out non-invasive evaluation of technologies with life style or drug intervention,For reducing the incidence and mortality of coronary heart disease and improving the quality of life of the people.There is an urgent need that is structure and function of the systematic technique for the development of coronary heart disease in all aspects of the characteristics,which can be used for the early clinical,non-invasive and easy-to-use assessment of coronary artery.In recent years,with the focus on prevention and treatment of vascular lesions of anterior,using non-invasive for detecting and screening coronary heart disease early become important.It is clear that the occurrence and development of atherosclerotic vascular disease require a long process,However,its mechanism may involve in impaired endothelial function,the changs arterial elasticity,inner membrane changes and inflammation.In view of the above aspects of the evaluation of the relevant means are caused by the academic attention.Impaired endothelial function are probably atherosclerosis initiating aspect,NO,ET-1,VWF can well reflect the changes in endothelial function,baPWV,PP,are a major indicators for reflecting arterial stiffness,ABI and cIMT indexs can reflect peripheral vascular changes and systemic atherosclerosis respectively,hs-CRP is a marker of inflammation.In the prevention and treatment of coronary heart disease,these indicators are representative to a certain degree,and have a lot of advantages such as it is non-invasive,cheap and easy to operate,is easy to follow-up for dynamic observating and assessing the efficacy and prognosis of patients compared with coronary angiography.Most research focused on one or two indicators to explore with coronary artery disease, However,there are less researchs from different aspects with numbers of indicators to explore coronary lesions,especially mild stenosis of coronary artery.This study will investigate the changs in coronary heart disease expecially at the mild stenosis of coronary artery.with a variety of non-invasive detection of the above indicators(NO,ET-1,VWF,baPWV,PP,ABI,cIMT,hs-CRP),To investigate the association between the changes and coronary coronary heart disease in particular,mild stenosis of coronary artery.Objective1,By observeing the changes of mild stenosis group of a variety of non-invasive detection indicators(NO,ET-1,VWF,baPWV,PP,ABI,cIMT,hs-CRP),to analyze the impact factors of mild stenosis of coronary artery,to investigate its clinical significance.2,By comparing the changes anmong the coronary heart disease in diffent lesions severity with a variety of non-invasive detection indicators(NO,ET-1,VWF,baPWV,PP,ABI,cIMT,hs-CRP),to explore the relationship between these changes and its clinical significance in coronary artery disease.Subjects and MethodsSubjectsThe patients who were in Guangzhou General Hospital of Guang Zhou Military Command from October in 2007 to September in 2008 were prepared to be given CAG,Those who suffer from myocarditis,a serious heart failure,and serious liver and kidney diseases,autoimmune diseases,blood diseases,inflammation and other serious systemic diseases were excluded.Methods1,One hundred and forty-nine patients given coronary angiography(CAG) were divided into three groups according to the result of CAG:coronary heart disease (CHD) group,mild stenosis of coronary artery group and control group.CHDgroup was diagnosed if diameter stenosis≥50%at least one coronary segment.,mild stenosis of coronary artery group was diagnosed if diameter stenosis≤50%.CHD group was divided into single-vessel group,dual-vesel group and three-vesel group (multiple-vesel or left main coronary artery lesions) in term of the numbers and the severious extent of coronary atrery artery lesions.2,Brachial-ankle pulse wave velocity(baPWV) and ankle-brachial index(ABI) were measure by a Colin system,PP could be calculated from SBP and DBP,which could reflect arterial flexibility and the lower extremity vascular disease respectively; cIMT was detected by Doppler echocardiographic examination.Serum level of NO,ET-1,VWF,hs-CRP were measured before angiography in all subjects.3,Results are expressed as mean±SD and analyzed by SPSS 10.0 Statistical sofware.One-way ANOVA analysis was used to analyze the difference among the control group,coronary artery early lesions group,coronary heart disease group in age,TG,TC,LDL-C,HDL-C,NO,ET-1,VWF,baPWV,PP,ABI,cIMT,hs-CRP.x~2 test was used to analyze the difference in sex,the rate of the cigarette,haypertension,diabetes.One-way ANOVA analysis was used to analyze the difference among among the single-vessel group,dual-vesel group and three-vesel group in NO,ET-1,VWF,baPWV,PP,ABI,cIMT,hs-CRP.When Homogeneity of variance multiple comparisons among each group LSD test was used,HoweverTamban-e's T2 is used.Logistic regression analysis was used for analyzing the major risk factors between The mild stenosis of coronary artery.A probability value＜0.05 was considered statistically significant.Results1,Significant differences were observed in NO,ET-1,VWF,baPWV,PP,ABI,cIMT,hs-CRP,smoking rate among the control group,mild stenosis group and coronary heart disease group(P＜0.05).Comparing with control group,ET-1,baPWV,PP,cIMT levels of mild stenosis group were higher,while serum level NO was lower, There were no significant differences in VWF,hs-CRP,ABI between mild stenosis of coronary artery group and control group.2,Logistic regression analysis show that NO,ET-1,baPWV,PP are the main risk factors during in mile stenosis of coronary artery independently from conventional atherosclerotie risk factors.NO(OR=0.930,95%CI:0.870-0.994,P＜0.05); ET-1(OR=1.102,95%CI:1.032-1.178,P＜0.01),PP(OR=1.093,95%CI:1.001-1.195, P＜0.05),baPWV(OR=1.009,95%CI:1.005-1.013,P＜0.01).3,In the analysis of the degree of coronary artery disease,Significant differences were observed in NO,ET-1,VWF,baPWV,PP,ABI,cIMT,hs-CRP,smoking rate among single-vessel group,dual-vesel group and three-vesel group(P＜0.05). Comparing with control group,ET-1,VWF,baPWV,PP,cIMT levels of single-vessel group,double-vessel group three-vessel group were higher,while serum level of NO was lower;Comparing with single-vessel group,ET-1,baPWV,cIMT levels of double-vessel group were higher,while serum level of NO is lower,ET-1,VWF,baPWV,PP,cIMT,hs-CRP levels of three-vessel group were higher,while serum level of NO,ABI is lower(P＜0.05);Comparing with dural-vesel group,ET-1,PP levels of three-vessel group group were higher(P＜0.05).Conclusions:1,Non-invasive detection of a variety of indicators(NO,ET-1,VWF,baPWV,PP,ABI,cIMT,hs-CRP) in patients with coronary heart disease have the relation to coronary artery disease,Compaing with control group,the dicreasing of the NO and the increasing of the ET-1,baPWV,PPin the mild coronary artery stenosis group have significant differences,Logistic regression analysis showed that NO,ET-1,baPWV,PP are related to mild coronary stenosis.2,VWF,ABI,hs-CRP is closely related to the extent of coronary artery disease, but the differences between mild stenosis group and control group were not significantly,these indicators may be not sensitive in evaluating coronary artery stenosis.