The Relationship Between Apolipoprotein A And Coronary Artery Stenosis In Patients Diagnosed With Acute Coronary Syndrome Accompanied By Type 2 Diabetes Mellitus

Background and objective:There are always a variety of complications in coronary heart disease(CHD),and type 2 diabetes mellitus(T2DM)as one of complications accounts for about 20%to 30%.Patients with CHD can exist abnormal lipid metabolism,as the same with T2DM.If the two diseases interact with each other,the disorder of lipid metabolism will become more serious.A large number of studies have confirmed that low-density lipoprotein(LDL-C)can promote the occurrence and development of atherosclerosis,and high-density lipoprotein(HDL-C)can suppress the formation of atherosclerotic plaque.Apolipoprotein A(ApoA)is an important component of HDL particles,and apolipoprotein B(ApoB)mainly exists in LDL particles.Multiple studies have confirmed the relationship of ApoA and coronary artery stenosis.However,there is no study about the classification and complications of coronary heart disease.By statistical analyzing the clinical data of patients with acute coronary syndrome(ACS)accompanied by T2DM,this research aims to study the relationship between ApoA and coronary artery stenosis in patients diagnosed with ACS accompanied by T2DM.At the same time,the correlation between ApoA and MACE after PCI treatment for such patients was analyzed.Method:A retrospective study was performed on continuous patients with ACS,who were admitted to Department of Cardiology of Shandong Provincial Hospital Affiliated to Shandong University between January 2018 to December 2019.Collected their general information,measured their fasting blood-glucose(FBG)and serum lipids,which including total cholesterol(TC),triglyceride(TG),HDL-C,LDL-C,ApoA,ApoB and lipoprotein a(Lpa),and calculated the ratio of serum lipids(including HDL-C/TC、LDL-C/TC、ApoB/ApoA).Examined their cardiac functions and recorded left ventricular ejection fraction(LVEF).Performed coronary angiography and calculated Gensini score.Called back to ask the prognosis of the patients with ACS and T2DM treated by PCI in 1 year.①There were 301 patients with T2DM(T2DM group)and 576 patients without diabetes(NDM group).Compared clinical data of T2DM group and NDM group and analyzed the differences in serum lipids between the 2 groups by independent-sample t test.②For patients with ACS and T2DM,divided them into three groups by Gensini score:low score group(≤30),medium score group(30.5-90)and high score group(>90).Analyzed the differences in general information and serum lipids between three groups by one-way analysis of variance.Used spearman correlation analysis to analyze the correlation between each serum indicator to Gensini score.Analyzed the correlation between general data and the above significant indicators to Gensini scores by multiple linear regression.③For patients with ACS and T2DM treated by PCI,called back to ask the prognosis of the patients with ACS and T2DM treated by PCI in 1 year.There were 55 of them occured major adverse cardiovascular events(MACE group)and 196 patients not occured major adverse cardiovascular events(non-MACE group).Compared clinical data of MACE group and non-MACE group and analyzed the differences in clinical data between the 2 groups by independent-sample t test.Multivariate logistic regression was used to identify independent associated factors for the occurrence of MACE in patients with ACS complicated with T2DM in 1 year after PCI.Result:①Compared clinical data between T2DM group and NDM group found that ApoB,LDL-C/TC,ApoB/ApoA of T2DM group was higher than NDM group,while HDL-C,ApoA and HDL-C/TC of T2DM group was lower than NDM group.The differences were statistically significant(P<0.05).For TG,TC,LDL-C and Lpa,there was no statistically significant between the two groups(P>0.05).②There are significant differences in LVEF and ApoA among the three groups(P<0.05).LVEF and ApoA was the highest in the low score group[(60.43±1.79)%、(1.10±0.16)g/L],followed by the medium score group[(57.84±5.87)%、(1.04±0.14)g/L],and finally the high score group[(54.74±9.24)%、(0.94±0.16)g/L].Spearman correlation analysis between each serum index to Gensini score showed that ApoA was negatively correlated with Gensini integral(r=-0.338,P<0.001),ApoB/ApoA was positively correlated with Gensini score(r=0.152,P=0.008).The results of multiple linear regression of Gensini score showed that age and ApoB/ApoA was positively correlated with Gensini score,while LVEF and ApoA was negatively correlated with Gensini score.The largest correlation was LVEF(β=-0.238,P<0.001),followed by ApoA(β=-0.181,P=0.005),and then was age(β=0.149,P=0.007),the last was ApoB/ApoA(β=0.122,P=0.045).③For patients with ACS and T2DM treated by PCI,the LVEF,HDL-C and ApoA of MACE group was lower than non-MACE group[(56.67±7.19)%vs(58.96±4.76)%、(1.03±0.26)mmol/L vs(1.12±0.25)mmol/L、(0.97±0.13)g/L vs(1.07±0.15)g/L],while ApoB/ApoA and Gensini score of MACE group was higher than non-MACE group[(1.05±0.36)vs(0.91±0.30)、(84.64±23.94)vs(39.07±21.80)].The differences were statistically significant(P<0.05).The results of multiple logistic regression showed that ApoA and Gensini score was independent associated with the occurrence of MACE for patients with ACS and T2DM treated by PCI in 1 year[OR=0.006,95%CI(0.000-0.163);OR=1.083,95%CI(1.058-1.104)].Conclusion:①For patients with ACS,there are differences in serum lipid metabolism between patients with T2DM and without diabetes.ApoB,LDL-C/TC,ApoB/ApoA in patients with T2DM is higher than that in patients without diabetes,while HDL-C,ApoA,HDL-C/TC is lower than that in patients without diabetes.②ApoA is an independent associated factor for the Gensini score in patients with ACS and T2DM.③ApoA and Gensini score are independent predictors of postoperative prognosis in patients with ACS and T2DM after PCI.