The Relationship Between Angiopoietin-like Protein 2 And CHD

BackgroundCoronary heart disease is the most common type of atherosclerosis-caused organopathy and also a common disease that seriously harms the health of human beings.The basic principle is atherosclerosis,the pathophysiology of which is the persistent chronic inflammatory responses in the vascular tissues.Among them,inflammatory reactions play an important role in plaque instability and plaque rupture.In recent years,angiopoietin-like protein 2(Angptl 2)has shown important roles in damaging the vascular endothelial cells and promoting the infiltration of macrophages in atherosclerotic plaques.Angptl 2 is closely related to the occurrence and development of cardiovascular diseases,but there is less research on the level of Angptl 2 in patients with coronary heart disease.Nowadays,a large number of new technologies for the diagnosis and treatment of cardiovascular diseases have been applied and shown their own advantages and disadvantages.In order to promote the diagnostic level,it is necessary to look for new markers.In order to find new pro-inflammatory indicators,we must do certain work so as to the research in this field.At present,Angptl 2 is considered as a new pro-inflammatory marker.In chronic inflammation of vessel walls,vascular remodeling and endothelial cell injury are closely related to the occurrence and development of cardiovascular disease.It can be seen that as a pro-inflammatory factor,Angptl 2 is closely related to the severity of coronary artery disease,ventricular remodeling after acute myocardial infarction,and premature myocardial infarction,etc.Although there are few reports on the correlation between Angptl 2 and coronary heart disease in foreign countries,these reports are mostly limited to the level of cells and animal experiments.and no such research has been reported in China.We carried out a relatively complete exploration of the risk factors,severity,and prognosis of Angptl 2 and coronary heart disease in a large sample size population.ObjectiveTo investigate the serum level of Angptl 2 in patients with coronary heart disease so as to discuss its potential predictive value and its clinical significance against coronary artery disease.MethodsPart one:A total of 262 Han patients,aged from 18 to 87 years old,undergoing coronary angiography from January 2016 to November 2016 in the emergency medical and cardiology ward of our hospital were collected.All the patients signed the informed consent and confirmed the situation by coronary angiography,medical records,and cardiologists;this study had been certified by the Hospital Ethics Committee.The selected patients were divided into the normal control group(C),the single-vessel disease group(S),the double-vessel disease group(D),and the triple-vessel disease group(T)according to the results of coronary angiography.According to the degree of stenosis of coronary artery disease,all the patients were performed basic scoring,and according to the Gensini score,all the patients were divided into the<30 points group(<30),the 30-90 points group(30-90),an>90 points group(>90).The clinical data,past medical history,blood and biochemical tests,electrocardiogram,and echocardiography of all the patients were collected,together with the results of coronary angiography.5 ml of fasting venous blood was sampled form each patient in the morning after 12-h fasting on admission,which was performed 30-min mixing,15-min centrifugation at 3,000 rpm,carefully collected the supernatant,and stored at-80? for the detection of the serum Angptl 2 level by ELISA.Part two:91 Han patients with STAMI initial onset of LAD for emergency PCI were selected from January 2016 to November 2016 in the emergency department and the Department of Cardiology in our hospital.All the patients underwent 24-hour electrocardiographic monitoring,and sampled 5 mL of venous blood at the 6th-8th hour of the 12 hours from the onset to emergency PCI to detect the serum Angptl 2 level.The selected patients were followed up for 30 days,six months,and one year,respectively,and divided into the MACE group(MACE)and the non-MACE group(non-MACE)according to the follow-up results to analyze the correlation of serum Angptl 2 level with cardiovascular events,arrhythmias,and cardiac function.Part three:The Han patients(?40 years old)hospitalized into the emergency department due to initial onset of STAMI from January 2016 to November 2016 were selected,together with 30 young patients and 35 patients(>40 years old)hospitalized due to STAMI in the same period.All the patients underwent percutaneous coronary angiography,and sampled 5 mL of venous blood immediately after admission to detect the serum Angptl 2 level.All the selected patients signed the informed consent,and this study had been approved by the hospital ethics committee.ResultsPart one:The serum level of Angptl 2 in patients with coronary heart disease was significantly higher than group C,which also increased gradually with the increase of the number of vascular lesions in coronary heart disease and was positively correlated with the degree of stenosis;the three groups with coronary heart disease showed significantly different Angptl 2 levels As the Gensini score increased,the serum Angptl 2 level also increased.The independent sample t-test revealed statistical significance between group C and other groups with coronary heart disease(P<0.05),indicating the concentration of Angptl 2 increased with the increase of the number and severity of coronary lesions;the intergroup differences were statistically significant(P<0.05).The independent sample t-test revealed that the differences among the groups with different Gensini scores were statistically significant(P<0.05),indicating that the Gensini score 'was positively associated with the number and severity of coronary lesions.The comparison among Group S,D,and T showed statistical significance P<0.05.the serum Angptl 2 level in all the study subjects(n=262)were associated with the common risk factors for coronary heart disease,leukocyte counts,hs-CRP,and N-proBNP level;it was found that the serum Angptl 2 level was positively correlated with the number of coronary lesion branch,diabetes history,fasting blood glucose,white blood cells,hs-CRP,N-proBNP,TG,Hcy-c,and Gensini score,and the correlation coefficients were 0.360,0.134,0.023,0.139,0.147,0.258,0.143,1.77,and 0.213,respectively.The Pearson correlation analysis of the serum Angptl2,N-proBNP,hs-CRP,or WBC level with the Gensini score of patients showed significant positive correlation(P<0.05).The multivariate regression analysis suggested that the serum Angptl2,N-proBNP,hs-CRP,WBC,Hcy-c,TG,fasting blood glucose,history of diabetes,and Gensini score of coronary angiography were the independently related factors of coronary lesions.From the standardized partial regression coefficients,it can be seen that the serum Angptl 2 and N-telo-brain natriuretic peptide level had the greatest impact on the number of coronary lesions,followed by the Gensini score and triglycerides.Part two:The study found that the serum Angptl 2 level in Group MACE,Group arrhythmia,and the patients with poor cardiac function was significantly higher than Group C.At the same time,the 30-day,half-year,and 1-year survival analysis toward the patients,as well as the multivariate logistic analysis,revealed that the serum Angptl 2 level was the strongest independent predictor of the 30-day major adverse outcomes;the EF value on the 30-day,half-year,and 1-year follow-up was significantly decreased.The size of the left ventricle was significantly reduced,the number of walking steps in 6-min walking test was significantly increased,and the EF value was increased by>15%than that on admission,suggesting that the level of serum Angptl 2 was an important predictor of STAMI ventricular remodeling in LAD lesions.Part three:It was found for the first time that the serum Angptl 2 level in young STAMI patients was much higher than that in elderly patients.The characteristics of young patients with STEMI were men,low education level,long sitting,and irregular life,and the number of coronary lesions was mostly single-vessel lesion and mainly in the descending coronary artery;the elderly exhibited mostly multi-vessel lesions and mainly in the anterior descending artery and the right coronary artery.The serum Angptl 2 level was positively associated with the NT-proBNP,TG,and hyperuricemia in young STAMI patients.The multivariate logistic regression analysis revealed that the fasting blood glucose,high uric acid,TG,cystatin c,Angptl 2,hs-CRP,age,smoking,history of hypertension,and EF were related to youth patients with STAMI,and the incidence rate in young patients was statistically higher than the elder,p<0.05,suggesting that Angptl 2 may be an early reliable predictor of STEMI in young adults and have a synergistic diagnosis with NT-proBNP.Conclusions1.It can be inferred that the serum Angptl 2 level is involved in the occurrence and development of coronary atherosclerotic lesions,and its serum level can be used to assess the coronary Gensini score,reflect the degree of coronary artery stenosis,and used as a detection index for clinical judgment of coronary artery disease.2.High serum Angptl 2 level can be used as a useful biomarker for predicting MACE 30 days after PCI in patients with STEMI initial onset of LAD.It can be presumed that high serum Angptl 2 level is an important predictor of STEMI ventricular remodeling in LAD lesions.3.It can be speculated that high serum Angptl 2 level may be a valuable early predictor of youth patients with STEMI.