| BackgroundCoronary atherosclerotic heart disease(CAD)refers to the heart disease caused by coronary vascular cavity stenosis or occlusion leading to myocardial ischemia,hypoxia or necrosis due to coronary atherosclerosis,collectively known as coronary heart disease or coronary artery disease,and is the most common cause of organ lesion caused by atherosclerosis(AS).There are two clinical classifications,including chronic myocardial ischemia syndrome and acute coronary syndrome(ACS).ACS refers to the acute ischemic heart disease,whose morbidity is increasing year by year in China,including acute myocardial infarction(AMI)and unstable angina(UA).The survey report of Chinese cardiovascular disease in 2016 published in 2017 showed that the morbidity and mortality in patients with acute coronary syndromes are rising year by year during recent 10 years.In addition,China PEACE research from 2001 to 2011 in the hospital data analysis showed that there is an upward trend in hospitalization rates in AMI patients,but no significant decrease in hospital mortality.Therefore,the judgment of coronary artery lesions in ACS,especially AMI,is one of the keys to assist clinical decision-making.At present,coronary angiography,the gold standard to evaluate the location and severity of coronary artery stenosis is invasive and costly.Thus,we aim to find the application value of complement system in the early diagnosis or prognosis of coronary heart disease by exploring its characteristics and clinical significance.Complement system is an important part of innate immunity,which plays their role in anti-infection,immune regulation and immune monitoring,and it can also lead to tissue damage under certain circumstances.The stability of plaque is closely related to inflammation,and the complement system plays an important role in the development of atherosclerosis.Complement Clq is an important initial component of the classical complement pathway and closely related to many chronic inflammatory diseases,including atherosclerosis.There are multiple interactions between the complement system and vascular endothelium,for example,mediating the expression of adhesion molecules and leukocyte mobilization,secretion of pro-inflammatory and chemokine factors,and increasing vascular permeability.On the one hand,the serum Clq induces Clq-polarization of macrophages toward an anti-inflammatory(M2-like)phenotype and lipid accumulation.On another hand,the coordination of inflammatory proteins in the immune response is lost,and classical complement pathway is initiated.Thus,the role of Clq as an indicator to assess the severity of inflammation and disease is still controversial.Currently,no study has been conducted to explore whether serum Clq is correlated with the severity of coronary artery disease.Therefore,we designed this study to explore the relationship between serum complement Clq level and the severity of coronary artery stenosis in patients with different types of ACS.Purposes1.To investigate the serum Clq level in patients of ACS.2.To study the association between serum Clq and the severity of coronary artery stenosis.3.To identify the value of serum Clq in predicting the severity of coronary artery stenosis.Materials and MethodsAccording to the inclusion criteria and exclusion criteria of the research,we recruited 320 patients who received CAG from October 2016 to November 2017 in qilu hospital of shandong university.All patients were stratified into non-ACS group(control group,n=74),unstable angina group(UA group,n=197)and acute myocardial infarction group(AMI group,n=49)according to the severity of coronary stenosis and clinical manifestations.Venous blood samples were collected from upper limbs of all participants.The severity of coronary stenosis was represented in Gensini score,and serum complement Clq level was compared using immunity transmission turbidity among three groups.We used the Gensini score as a dependent variable to describe and judge the severity of coronary stenosis.Statistical Package for Social Science(SPSS,version 22.0)were executed to analyze the statistics and P<0.05 was considered statistically significant.Results(1)According to the statistics,there were no marked differences in gender,age,diastolic blood pressure,heart rate,height body mass index(BMI),smoking history,drinking history,hypertension history and family history of cardiovascular disease between UA group,AMI group and control group.Compared with the control group,the systolic blood pressure(SBP)of UA patients was obviously increased(P<0.05)and the rate of UA and AMI patients with diabetes was significantly increased(P<0.05).Compared with the UA group,the systolic blood pressure of AMI patients also increased(P<0.05).In addition,compared with the control group and UA group,aspartate aminotransferase(AST),creatine kinase isoenzyme(CK-MB)as well as cardiac troponin I(cTnl)were significantly increased in AMI patients(P<0.05).The Gensini scores of the control group,UA group and AMI group showed an upward trend(P<0.05).(2)There was no statistical difference in serum complement Clq level between the control group and ACS patients.After further grouping,the level of complement Clq in AMI group was lower greatly than control group and UA group(P<0.05).(3)Multivariable linear regression analysis of complement Clq showed that gender,age and high-density lipoprotein cholesterol(HDL-c)were negatively correlated with Clq level(P≤0.001),while positively correlated with triglyceride(TG)and fasting glucose(FBG)(P=0.001～0.014).(4)There was no correlation between serum complement Clq and Gensini score(β=-0.086,P=0.125)without controlling the confounding factors.In nitrate-taking patients,serum complement Clq had a negative association with Gensini score(r=-0.275,P=0.001),and in non-smokers,there was also a negative correlation(β=-0.159,P=0.036).After calibrating smoking,drinking or statins,the serum complement C1q levels of control group,UA group and AMI group decreased in sequence(P＜0.05).Logistic regression analysis showed that the decreasing of serum complement Clq was an unfavorable factor for acute myocardial infarction(OR=0.984,95%CI:0.972～0.997,P=0.015)and for ACS(OR=0.984,95%CI=0.971～0.984,P=0.025)in drinking patients.(5)Analyzed with ROC carve to explore the serum complement Clq in estimating coronary stenosis,the AUC of complement Clq was 0.568(95%CI=0.492-0.644,P=0.076),while the sensitivity was 73.6%and the specificity 58.1%.Conclusion1.Serum complement Clq in ACS patients,in particular AMI patients,showed lower level.2.In non-smoking people,there are negative correlation between complement Clq level and the severity of coronary artery stenosis,which could reflect the severity of coronary artery stenosis.3.Serum complement Clq was a protective factor for AMI and the decreased level may prompt the increase of the severity of coronary artery stenosis.4.Serum complement Clq level can help predict the risk of coronary heart disease and judge the severity of coronary artery disease.BackgroundPercutaneous transluminal coronary intervention(PCI)is the main effective means for the diagnosis and treatment of coronary heart disease,and the prevention of in-stent restenosis(ISR)is an important objective after PCI operation.Currently,dual antiplatelet therapy(DAPT)is recommended for postoperatively antiplatelet therapy,but recent studies have found that some patients may develop "resistance" to aspirin or clopidogrel,which leads the decreasing effect of antiplatelet therapy and the significantly increasing risk of ISR.In addition to being an independent risk factor for in-stent restenosis,diabetes mellitus also increases the risk of "resistance" and seriously affects the prognosis of diabetic patients.The cilostazol has been proven that it can reduce the risk of in-stent thrombosis in patients with diabetes and reduce the incidence of restenosis within six months.However,there is no evidence-based research on the relation between cilostazol and triple antiplatelet therapy(TAPT,based on cilostazol and the other two drugs),and the risk of long-term(≥6 months)ISR in the diabetic population.long-term ISR diabetic patients.Materials and MethodsWe conducted a comprehensive online search of the three databases,PubMed,EMBase and Cochrane Library,in accordance with the flow chart.We searched the citations included in the study to avoid omission of randomized controlled trial(RCT).The search deadline is May 20,2019.Literature retrieval,literature quality evaluation,data and relevant information extraction were executed respectively by two reviewers,and the above results would be cross-checked.In case of disagreement,two reviewers would analyze and discuss to solve the problem,or the third reviewer could be asked for a ruling.The extracted data includes the baseline characteristics(the first author,year of publication,area of the sample,sample size,the basic characteristics of the samples(age,gender,diabetes type),research methods and the application of cilostazol(loading and maintenance dose,duration),the medicine of control group and follow-up time,ending indicators(postoperative ISR).The primary endpoint event was the imaging ISR,defined as>50%of the radius of in-stent stenosis.If the ISR was not clearly clarified,the restenosis of imaging was included as ISR data.Random effect model or fixed effect model was used for data analysis according to the degree of heterogeneity,and the publication bias was evaluated by symmetry test of funnel plot.ResultsAccording to the inclusion criteria,a total of 1276 diabetic patients receiving PCI in 5 randomized controlled trials were included in this study.And 636 were treated with cilostazol.Compared with the control group,the use of cilostazol can reduce the risk of long-term ISR in diabetic patients[RR:0.55,95%CI:0.39～0.76],and cilostazol-based TAPT also can reduce the occurrence of long-term ISR in diabetic patients[RR:0.65,95%CI:0.44～0.96].Conclusion1.The application of cilostazol in diabetic patients after PCI can effectively reduce the risk of long-term ISR.2.The application of cilostazol-based TAPT in diabetic patients after PCI can effectively reduce the risk of long-term ISR. |
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