Study On The Level And Relationship Between Serum Visfatin, MMP-9 In Patients With Coronary Heart Disease And Insulin Resistance

Backgroud:Insulin resistance (IR) is a hotspot in recent years, which definition is that a certain amount of insulin (Ins) is expected to produce biological effect below normal levels. The body tissues or target cells to Ins reactivity and sensitivity reduced, and that function below the normal reaction. American Reaven discovered IR which is named X syndrome(Metabolic syndrome) with hyperinsulinemia, abnormal glucose tolerance, hyperlipidemia and hypertension for the first time in 1988. There are many researches about IR and Coronary heart disease(coronary heart disease, CHD). At present, CHD is the most common domestic cardioascular disease, which has become the one of important disease endangered human existence with its mortality and morbidity rates rise gradually. CHD also is the main cause of death. Cardiovascular disease mortality accounted for the death toll thirty percent, however, IR can lead to clinical cardioascular complications through direct and indirect effect, especially CHD. Previous study usually just consider all sorts of risk factors alone to the influence of CHD. Along with the concept of IR becames more clearer gradually, the epidemic factor of CHD was began to considered comprehensively. Some studies have shown that cardiovascular disease can increase the odds of two or more times alone with the rise of HOMA-IR index. In addition, coronary artery disease's degree and range also shows a tendency to increase. In recent years, the adipose tissue is an endocrine organs which secretes plenty fat cells factor and hormone, its fuction is taken seriously more and more.For example, Visfatin is a new fat cell that is mostly secreted and expressed in visceral fat tissue recently and have various biological activities. Its level's increases can continually stimulate insulin receptor, make receptor cut and aggravate IR eventually. It shows that Visfatin may plays an important role to prevent the occurrence of IR. Current research results confirm that Visfatin has close relation with inflammation. As a former inflammation factors, Visfatin can induce the secretion of the IL-8 and TNF-a, especially the IL-6. Matrix metalloproteinase-9(MMP-9) is the important member in the family of MMPs, which is compound by activated endothelial cells, fibroblasts, macrophages and so on, and secreted in the form of precursor of protease original. MMP-9 influences the atherosclerosis through the extracellular matrix (ECM) degradation. Besides, the study of the relationship between MMP-9 and the atherosclerosis risk factors is increasing, but the report of the relationship with IR less. The research shows that signal which inhibits IR's maturity can inhibits the productive of MMP-9 induced by Ins. It promotes a former inflammation state potentially and adds the disability and death of cardiovascular among patients who have IR and diabetesⅡwhen MMP-9 is induced by Ins. Up to now, the study about Visfatin and MMP-9 mostly has focused on the formation mechanism and connection of the atherosclerotic plaque. There is few report about the research and relationship between serum Visfatin and MMP-9 in the level among patients with CHD and IR.Objective:To investigate the level of serum vifatin, MMP-9 in the patients with CHD with IR, and the influence factors of coronary atherosclerosis.Method:According to the standard of inclusion and exclusion, eighty patients who had accepted coronary angiography in the first hospital of jilin university were recruited. According to the level of homeostasis model assessment (HOMA-IR), HOMA-IR≥2.8 as the standard of IR, thirty-two patients were classified as coronary heart disease with insulin resistant(CHD with IR), and twenty-eight as coronary heart disease without insulin resistant(CHD without IR). Another 20 healthy individuals were selected as the control group. Height, weight, blood pressure were measured, and fasting serum glucose, insulin, triglycerides, total cholesterol, high density lipoprotein-cholesterol and low density lipoprotein-cholesterol were also analyzed; serum concentrations of Visfatin and MMP-9 levels were measured by the Elisa method; HOMA-IR was calculated as a evaluation method of insulin resistance; Coronary artery's stenosis degree were measured by coronary angiography.Result:(1) In the patients of CHD with IR, there are primarily moderate and severe atherosclerosis at coronary artery's stenosis degree. In the patients of CHD without IR, there are primarily mild and moderate atherosclerosis at coronary artery's stenosis degree; (2)Serum concentrations of Visfatin, MMP-9 in the patients of control group, CHD without IR and CHD with IR were increased gradually, and compare with each other, there is a statistical significance(P<0.05; (3)In the patients with CHD, both IR and Gensini integral were positively correlated with serum concentration of Visfatin (r=0.5549, P<0.01; r=0.6231, P<0.01); both IR and Gensini integral were positively correlated with serum concentration of MMP-9 (r=0.4211, P<0.01; r=0.6179, P<0.01); there was positive correlation between Visfatin and MMP-9(r=0.6377, P<0.01); there was positive correlation between Gensini integral and IR(r=0.5023, P<0.01).Conclusions:(1)IR is an risk factor of CHD; (2)Serum concentra-tions of Visfatin and MMP-9 have the positive relationship between each other and also with insulin resistant; (3)Serum concentrations of Visfatin and MMP-9 have the positive relationship with coronary stenosis degree, in addition, the rise of those level may accelerate coronary atherosclerotic's process, which can become predictors of cardiovascular disease; (4)Serum concentrations of Visfatin and MMP-9 combined with coronary angiography have synergy in the detection for coronary stenosis degree in the patients with CHD.