Polymer Adiponectin, Acid Secreted Proteins That Are Rich In Cysteine With Clinical And Prognostic Analysis Of Coronary Heart Disease (chd)

[Background]Investigating potential risk factors of coronary artery disease (CAD) has been an emerging hot spot in the filed of cardiology. While focus of which is the study of adipocytokins. As a kind of adipocytokins,numerous researches suggested that total adiponectin play an important protective role in the pathogenesis, development of CAD. High molecular weight adiponectin (HMWAPN), the subtype of adiponectin exerts this biological activity in most of the time. Until now, adiponectin is one of the most potential adipocytokins for the prediction and prognosis of CAD while whether the subtype of which, especially HMWAPN has effect on CAD and its prognosis remains uncertain. In the meanwhile, Secreted protein and riched in cysteine (SPARC) has gradually been recognized that it also has an certain effect on the pathogenesis of CAD while this effect, to our knowledge, was rarely investigated before and not well understood。[Objective]To explore the relationship between serum TAPN level、HMWAPN level、 HMW/TOTAL-adiponectin(H/T) ratio、SPARC level and CAD risk factors、the severity of coronary artery in the patients with CAD and to investigate the relationship between the above four factors and prognosis of CAD, mainly include main adverse cardiovascular and cerebral vascular events (MACCE)[methods]A total of503hospitalized patients underwent coronary angiography, who were in Beijing, from July2007to May2009in Peking Union Medical College Hostipal were included. All patients’ clinical data, including classic cardiovascular risk factors, past medical history, lab tests(include serum HMWAPN TAPN and SPARC), creatinine clearance, left ventricle ejection fraction were collected after admission. Every subject was calculated gensini score、modified gensini score and diffuse score according to their results of coronary angiography to quantify the severity of coronary artery. Those patients (449cases) with proved CAD by coronary angiography were followed up till December2012. The primary end point was the occurrence of major adverse cardiovascular cerebral vascular events (MACCE), including cardiovascular death, targeted vascular revascularization, acute coronary syndrome and deterioration of cardiac function, transient ischemic attack and stroke. And analysis was conducted to identify the relationship between TAPN level、HMWAPN level、HMW/total-adiponectin ratio、 SPARC level and CAD risk factors、the severity of coronary in the patients with CAD and to investigate the relationship between the above four factors and the prognosis of CAD.[Results]1,178MACCE occurrenced during the period of follow up (the average follow up month is54.4±5.7), and the incidence of MACCE was39.6%. Compared with the first follow up (March2010) results, cardiac death, target vessel revascularization, stroke had a higher growth rate which reached212.5%,116.7%and120.0%, respectively.2, Adiponectin and CAD:(1) Serum HMWAPN、TAPN level of dislipidemia were more lower than of normal in male patients with CAD (p<0.05or0.01). While in female patients with CAD, there is no significant difference of Serum HMWAPN、TAPN level and H/T ratio in every subgroups (p>0.05).(2) Correlation analysis revealed that Serum HMWAPN、TAPN level had a negative association with the number of risk factors、body mass index (BMI)、creatinine clearance in male patients with CAD(p<0.05or0.01). While in female patients with CAD, Serum HMWAPN TAPN level and H/T ratio had no association with various clinical indicators (p>0.05).(2) COX regression analysis found that the low level of HMWAPN (p=0.022, RR=1.656) and H/Tratio (p=0.002, RR=2.048) were independent risk factors for occurrence of MACCE in male patients with CAD and low level of HMWAPN (p=0.004, RR=2.832) and TAPN (p=0.003, RR=2.802) were independent risks factors in female patients with CAD.3, SPARC and CAD:(1) Correlation analysis found that:serum SPARC had a positively correlation with hypersensitive c-reactive protein (hsCRP) and Gensini score, modified Gensini score and diffuse score,(p<0.05), the multifactor linear regression analysis revealed that serum SPARC was an independent factor for the the severity of coronary artery(Gensini score)(p=0.023).(2) COX regression analysis found that serum SPARC levels had no effect on the incidence of MACCE for CAD patients (p>0.05).[Conclusion]1, The proportion of cardiac death, target vessel revascularization and deterioration of cardiac function had been gradually rised in the total MACCE with the extension of follow-up.2, The HMWAPN level and H/T ratio were independent protective factors for the incidence of MACCE in male patients with CAD while TAPN level was irrelevant, And this protective effect was not affected by the traditional risk factors of CAD. The decrease level of HMWAPN could be a predictor of a poor prognosis in this group.,3, The TAPN and HMWAPN level were independent protective factors for the incidence of MACCE in female patients with CAD while H/T ratio was irrelevant, And this protective effect was also not affected by the traditional risk factors of CAD. The decrease level of HMWAPN and TAPN could be a predictor of a poor prognosis in this group.4, SPARC level was assocated with the severity of coronary artery and may play a certain role in the pathogenesis of coronary atherosclerosis, and also has a role of early warning for the CAD. SPARC had no significant correlation with the incidence of total MACCE in patients with CAD, but may have some tips for occurrence of ACS and heart function deterioration in future.