Elevated Plasma Angiopoietin-like Protein 2 In Patients With Lower Extremity Peripheral Arterial Disease

Background:Non-communicable diseases (NCDs), also known as chronic diseases do not spread from person to person, mainly including cardiovascular diseases (CVDs), cancer, chronic respiratory disease,and diabetes etc. The disability and mortality rates induced by chronic diseases are higher than any other cause, which also lead to significant social and economic burden. Lower extremity peripheral atherosclerosis disease (LEPAD) is a kind of chronic diseases serious harm to human health. The early symptom of LEPAD is intermittent claudication, accompanied by severe ischemia and painful symptoms. Lower extremity numbness is also found in LEPAD, and Late period of LEPAD may cause ulceration and lower limb gangrene. The incidence of LEPAD remains high in the elderly. As China's accelerated aging society, elderly common diseases such as LEPAD need to be more emphasis on. Angiopoietin-like protein 2 (ANGPTL2) is a newly discovered adipokines, which can promote vascular inflammation and atherosclerosis formation.Objectives:The purpose of this study was to investigate the relationship between the changes of ANGPTL2 levels in the patients with lower extremity atherosclerotic disease, and the relationship between serum ANGPTL2 and clinical and biochemical indicators.Methods:Disease group screening:ankle-brachial index (ABI) as less than 0.9 as the diagnostic criteria of lower extremity atherosclerotic disease. Exclusion criteria of disease group:patients with acute coronary syndrome, acute cerebrovascular event, heart failure and type 1 diabetes. Selecting 90 cases of normal volunteers as control group at the same period, and exclusion criteria of control group:suffering from lower extremity atherosclerotic disease, acute coronary syndrome, acute cerebrovascular event, heart failure, type 1 diabetes patients. When fasting,3 mL venous blood was exsanguinated, immediately 1500 r/min of centrifugation for 10 min, serum was placed at -80 ? refrigerator for use. Smokers:current smoking or have quit smoking for five years. Hypertension:hypertension, receiving antihypertensive therapy, or systolic blood pressure ?140 mmhg or diastolic blood pressure ?90 mmhg. Diabetes:fasting blood glucose ?7.0 mmol/L, or accept hypoglycemic therapy. Using enzyme-linked immunosorbent assay (ELSIA), the serum angiopoietin-like protein 2 (ANGPTL2) and adiponectin (ADP) levels was detected in 128 cases of lower extremity peripheral atherosclerotic disease (LEPAD) in patients (case group) and 90 cases of non-LEPAD volunteers (control group). The serum fasting glucose, insulin, high density lipoprotein (HDL), HbAlc, low density lipoprotein (LDL), high-sensitivity C reactive protein (hsCRP), total cholesterol (TC), triglyceride (TG) and creatinine levels were detected by using the automatic biochemical analyzer. While collecting the basic informations such as age, sex, height, weight, blood pressure, medical history, smoking, alcohol consumption and so on were collected in this study, and body mass index (BMI) was calculated. Statistical analysis was used to test the parameters which were different in the normal control group and lower extremity peripheral atherosclerotic disease (LEPAD) group, and the diagnostic capability analysis of serum angiopoietin-like protein 2 (ANGPTL2) was carried out by ROC curve analysis. The univariate and multivariate statistical methods were used to analyze the correlation between angiopoietin-like protein 2 (ANGPTL2) and other biochemical indicators, as well as the correlation between angiopoietin-like protein 2 and the ankle-brachial index (ABI). Binary logistic regression analysis was used to analyze the risk factors of lower extremity peripheral atherosclerotic disease (LEPAD).Results:The serum ANGPTL2 levels in the lower extremity peripheral atherosclerotic disease (LEPAD) patients were significantly higher than that in controls (16.66 ± 9.47 vs 10.31 ± 6.32 ng/mL, p ?0.0001). Compared with control group, systolic blood pressure (SBP), fasting blood glucose level, HOMA-IR, insulin, creatinine, and high-sensitivity C-reactive protein (hsCRP) levels increased in the lower extremity peripheral atherosclerotic disease (LEPAD) (p= 0.006, p= 0.009, p <0.0001, p?0.0001, p= 0.02, p?0.0001, respectively). And diastolic blood pressure (DBP), high density lipoprotein (HDL) and ankle-brachial index (ABI) levels decreased in the disease group (p= 0.02, p= 0.003 and p?0.0001, respectively). The serum ANGPTL2 levels were positively correlated with the HOMA-IR and insulin levels (r= 0.260, p<0.0001 and r= 0.303,p?0.0001), and negatively correlated with the ankle-brachial index (ABI) (r=-0.388, p ?0.0001). The relative risk of lower extremity peripheral arterial disease was 1.11 (95% confidence interval 1.06,1.17) when the serum Angptl2 elevated. Compared with controls, serum ANGPTL2 levels increased in lower extremity peripheral atherosclerotic disease (LEPAD) patients, and negatively correlated with the ankle-brachial index (ABI).Conclusions:The elevated ANGPTL2 levels were associated with an increased risk of tower extremity peripheral atherosclerosis disease (LEPAD).