| Backgroud of the researchCoronary atherosclerotic heart disease: This is a kind of heart disease caused by coronary arteriosclerosis narrowing or blocking the blood vessel cavities or(and) the changing(spasm) of the function of the coronary artery leading to myocardial ischemia, hypoxia, or necrosis, and it is abbreviated as coronary heart disease(CHD). It has been clinically divided into two types, that is, the acute coronary syndrome and the chronic coronary artery disease. The former includes unstable angina pectoris, non-ST segment elevation myocardial infarction and ST segment elevation myocardial infarction; while the latter includes stable angina pectoris, normal coronary angina pectoris, silent myocardial ischemia, and ischemic heart failure. The morbidity of CHD in China has been in the period of continuous uprising and it also tends to occur on young people. It ranks top in the morbidity and mortality among the diseases of circulatory system for old people. CHD has become one of the serious public health problems seriously harming the mental and physical health of people.Current status of and problems existing in the diagnosis of CHD:There are many methods for diagnosing CHD, and blood lipid, blood sugar, body weight, blood pressure, age, and gender, etc., were all the factors affecting CHD. In clinical practice, whether there is myocardial ischemic necrosis is determined through typical clinical symptoms combined with auxiliary examinations to identify evidences for myocardial ischemia or coronary artery occlusion and myocardial injure markers. Examining methods commonly used for identifying myocardial ischemia include routine electrocardiogram, electrocardiogram stress test, and isotopic myocardial imaging, CT or MRI angiography etc. Invasive examination consists of coronary arteriography and intravascular ultrasound, etc., among which the coronary arteriography examination is the golden standard for the diagnosis of CHD. Although the coronary angiography examination has the highest accuracy for coronary,but because it is an invasive examination, there is a considerable part of the patients, especially those old patients due to a variety of factors in mind, body or inspection fees as a result of which should be done has not been do coronary angiography examination,and they could only be diagnosed through other clinical methods, which would lead to misdiagnosis some times and thus delaying the treatment. Therefore, how to identify CHD in early stage and conduct interference on them are the key points for the researches on CHD. In addition to the aforementioned items for examination and test, it is also expected in clinical practice that more simple and sensitive new technologies and methods of high specificity could appear.Adenosine monophosphate-activated protein kinase(AMPK) is a protein kinase for the regulation of energy metabolism and formed by the catalytic subunit α as well as regulatory subunit β and γ through different arrangement and space conformation. The subunit α has two subclasses of α1 and α2, which are both expressed in endotheliocytes with the α1 expression as the dominant one. AMPK is closely related to the formation of coronary arteriosclerosis, and it shows its protective function through regulating the endotheliocytes, smooth muscle cells, and macrophages of the cardiovascular system. Some researchers have proved that slight increasing of the blood vessel burden would promote the expression of the AMPK activity in cardiovascular events, but excessive harm could prohibit the activation of AMPK. Within the current researches there are more researches on the relevance of subunit α to coronary arteriosclerosis, and some researches held that AMPKα1 had stronger effect on the expression and activity of total AMPK. Most of the aforementioned analyses were mainly focusing on cells and animal experiments, and there are few clinical researches,and we speculate that the coronary heart disease population, the lower plasma AMPKα1 with people in coronary heart disease than non-coronary heart disease population. Therefore, this project begins from the views of the basic researches related to AMPKα1 and takes the enzyme-linked immunosorbent assay technology as the methods for this research to plan to conduct analysis on the concentration of AMPKα1 in the serum of the patients with CHD so as to confirm its relationship with CHD and establish the CHD serum AMPKα1 diagnosis mode, which could not only provide objective and reliable diagnostic evidences for the diagnosis and surveillance of CHD but also supply clinical basis for further researches on the function and mechanism of AMPKα1 in CHD, so it is of extremely important theoretical and useful values for further exploring the pathogenesis of CHD and improve the clinical treatment level of CHD.ObjectiveIn light of the aforementioned findings, this research has taken old patients with CHD as the major target and the enzyme-linked immunosorbent assay technology as the measures for research to plan to analyze the concentration of AMPKα1 in the serum of the old patients with CHD so as to confirm its relationship with CHD and establish the CHD serum AMPKα1 diagnosis mode.Methods5ml of whole blood was collected from each of the 133 patients(Age> 60 years old, no matter male or female)receiving coronary angiography and hospitalized in the Department of Geriatrics in the Southwest Hospital of the Third Military Medical University during the period from May 2014 to December 2014, and then the plasma was separated and stored in freezing condition. According to the results of the coronary angiography, the 133 patients were divided into the group of CHD(n=66) and the control group with negative results of coronary angiography(n=67), there was no difference between the two groups in smoking index, blood pressure, fasting blood glucose, serum creatinine at baseline(P<0.05). The enzyme-linked immunosorbent assay technology(ELISA) was adopted to test the concentration of AMPKα1 and the level of nitric oxide(NO) within the 133 plasmas, and in the meanwhile the case materials on the conditions of the 133 patients after they were hospitalized as well as the results of the laboratory auxiliary examinations were collected for conducting related analysis.ResultsCompared to the control group, the AMPKα1 and NO in the CHD group had significantly decreased [( 17.35±7.47) VS(29.15±11.17) 、( 60.14±26.02) VS(111.36±21.67),P<0.01]; the AMPKα1 level was of positive correlation to NO and high density lipoprotein cholesterol(HDL-C) and of negative correlation to triglyceride(TG), total cholesterol(TC), low density lipoprotein cholesterol(LDL-C), and D-dipolymer(P<0.05).ConclusionThe AMPKα1 in the CHD group had significantly decreased compared to the controlgroup,The reducing level of AMPKα1 related to the development of CHD of old patients.This study established the CHD serum AMPKα1 diagnosis mode, and it provided a new way for clinical diagnostic laboratory diagnosis of CHD. |
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