| Objective:Coronary slow flow(CSF)is of great clinical harm,so it is important to study the pathogenesis of CSF.Inflammatory response is the key pathogenesis of many cardiovascular diseases,which is closely related with the clinical manifestation of coronary artery.However,the role of inflammatory response in CSF is not very clear.Methods:The coronary blood flow was evaluated by the corrected thrombolysis in myocardial infarction(TIMI)frame count(CTFC).100 cases with slow flow(CSF Group)and 100 cases with normal flow(Control Group)were selected from patients undergoing coronary angiography(CAG)in our hospital from July,2016 to September 2017,then the study analyzed the demographics,physical characteristics,baseline biochemistry of the patients and compared the inflammation factors both in the peripheral blood(ulnar vein)and in the local blood(coronary artery),including matrix metalloproteinase-9(MMP-9),interleukin-6(IL-6)and C reactive protein(CRP).The CSF cases were randomly divided into two subgroups: routine treatment group(50 cases,atorvastatin,20 mg qn)and intensive treatment group(50 cases,atorvastatin,80 mg qn).Major adverse cardiovascular events(MACE)and the safety of intensive statin were tracked during in-hospital and following-up.After continuous medication for three months,CSF group received CAG again to evaluate the blood flow in the target coronary artery,and the inflammation factors were compared again between the subgroups.Results:CTCF value in CSF group was significantly higher than control group(left anterior descending/LAD: 49.5±4.6 vs.37.2±3.0,p<0.05;left circumflex branch/LCX: 35.2±4.3 vs.23.5±3.4,p<0.05;rightcoronary artery/RCA: 34.8±3.7 vs.21.4±3.3,p<0.05).Obesity/Body Mass Index(BMI,27.9±1.9vs.22.4±2.0,P<0.05),high uric acid(UA,496±105vs.288±65,P<0.05),high low density lipoprotein(LDL,4.23±0.61 vs.2.27±0.45,P<0.05),diabetes mellitus(DM,58,58.0%vs.27,27.0%,P<0.05)are independent risk factors for CSF.In control group,the levels of MMP-9,IL-6,CRP in peripheral blood were similar to those in coronary artery(MMP-9:143.5±26.9vs.150.7±29.0,P>0.05;IL-6: 3.97±0.95 vs.4.05±1.09 P>0.05;CRP:5.0±0.4vs.5.0±0.4,P>0.05).Compared with control group,the levels of MMP-9,IL-6 and CRP in peripheral blood were increased in CSF group,but there was no significant difference between them(MMP-9:158.3±30.0vs.143.5±26.9,P>0.05;IL-6 4.17±1.11 vs.3.97±0.95,P>0.05;CRP:5.2±1.4vs.5.0±0.4,P>0.05).The level of MMP-9 in the affected coronary artery of CSF group was significantly increased,compared to that in the peripheral blood of same group(197.6±35.4vs.158.3±30.0,P<0.05)and that in the coronary artery of control group(197.6±35.4vs.150.7±29.0,P<0.05).The levels of IL-6 and CRP in the affected coronary artery were similar to those in the peripheral blood of CSF group(IL-6:5.21±1.34 vs.4.17±1.11,P>0.05;CRP:6.3±1.8vs.5.2±1.4,P>0.05),higher than those in the coronary artery of control group,but the differences were not significant(IL-6:5.21±1.34 vs.6.3±1.8,P>0.05;CRP: 6.3±1.8vs.5.4±1.0,P>0.05).After taking atorvastatin for 3 months,alanine transaminase(ALT)and creatine kinase(CK)in intensive group were not significantly higher than before or those in routine group(ALT:35±7.0vs.27±7.032±6.5,P>0.05;CK:3.0±0.8vs.2.2±0.31.5±0.2,P>0.05),but LDL was significantly lower in intensive group(1.82±0.51 vs.4.23±0.612.05±0.42,P<0.05,P<0.05).The blood flow in intensive group was faster at the second CAG than the first one(LAD: 40.3±3.4vs.49.5±4.6,p<0.05;LCX:27.6±3.9vs.35.2±4.3,p<0.05;RCA: 25.7±3.6vs.34.8±3.7,p<0.05),and the level of MMP-9 in the affected coronary artery was lower(157.2±32.8vs.197.6±35.4,P<0.05).Although both CTFC value and MMP-9 werelowerin routine group in the second CAG,compared to the first one,there were no significant differences(LAD:36.4±3.7vs.37.2±3.0,p>0.05;LCX:21.8±4.0vs.23.5±3.4,p>0.05;RCA: 20.1±3.2 vs.21.4±3.3,p>0.05;MMP-9: 138.6±28.0vs.143.5±26.9,P>0.05).Conclusion:Compared with the inflammatory response in peripheral blood,the one in the targeted coronary artery was more relative to CSF.MMP-9 played an important role in the pathogenesis of CSF,and intensive statin therapy is effective and safe in the treatment of CSF. |
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