| Background and ObjectivesCoronary heart disease is a common cardiovascular disease which seriously threat human health and safety. There are multiple factors that infect the occurrence and development of coronary heart disease. Currently the imbalance of coronary regulation network induced by abnormal vasoactive cytokines has been considered closely related to coronary heart disease.B-type natriuretic peptides (BNP) is another member of natriuretic peptide which play an important role in cardiovascular disease. BNP antagonizes renin-angioensin-aldosterone system, reduces sympathetic tone, expands the blood vessel, produces diuresis and natriuresis, againsts vascular smooth muscle cells and endothelial cell proliferation. Besides the increase of ventricular wall tension and pressure overload,there are a lot of factors can stimulate heart to synthetize, secrete and release BNP, such as myocardial ischemia, some neurohomonal substances, cytokines, et al. BNP precursors was generated after the enzymatic hydrolysis of N-termimal proBNP (NT-proBNP) and mature BNP, the two equmoore released into the blood. NT-proBNP is often used for clinical testing due to longer half-life, smaller individual differences, higher stability. Apelin, the novel endogenous ligand for the seven transmembrane G-protein coupled Peceptor (an angiotensinⅡreceptor-like protein, called APJ), was extracted from the secretions of bovine stomach by Tatemoto et al using "orphan receptor strategy" reverse pharmacology method in 1998. APJ receptor and its endogenous ligand apelin were distributed widely in the body, which determines the Apelin-APJ system with a wide range of biological effects:expanding blood vessels, lowering blood pressure, increaseing myocardial contractile force, promoting angiogenesis,adjusting water and salt balance, regulating immunity and insulin-axis and so on.There are concrete on plasma NT-proBNP levels in patients with coronary heart disease recently. It has not yet clarified and rare reported that significance of plasma Apelin-12 levels change in patients with coronary heart disease. It is unknown that relationship of plasma NT-proBNP and Apelin in the development of coronary heart disease. The purpose of the study was to detect the changes of plasma NT-proBNP and Apelin-12 levels in patients with different clinical types of coronary heart disease, in order to analyze the correlation of the two factors, judge the relationship with severity of coronary lesions, reveal the changed trends of the plasma NT-proBNP and Apelin-12 in patients with coronary heart disease in the pathological developing process of coronary heart disease and clinical implications.Objects and methodsAll patients with coronary heart disease were chosen from cardiovascular department of the second hospital affiliated hospital of Zhengzhou university from December 2008 to December 2009. Patients with coronary heart disease diagnosed by coronary angiography and clinical standards, were divided into three groups:Acute myocardial infraction (AMI) group,41 cases, including 32 males and 9 females, the average age was (59.85±11.89) years old. Unstable angina pectoris (UAP) group,34 cases, including 25 males and 9 females, the average age was (64.65±9.24) years old. Stable angina pectoris (SAP) group,23 cases, including 17 males and 6 females, the average age was (60.57±10.98) years old.20 patients without CHD were selected as the control group including 14 males and 6 females, the average age was (60.25±11.38) years old. There was no difference between the CHD group and the control group in clinical characteres of age, gender, hypercholesteremia, hypertension, diabetes and left ventricular ejection fraction (P>0.05). All the patients were taken 3ml venous blood of limosis when they admit to ward in second day. The plasma NT-proBNP level of the blood samples was measured by electrochemiluminescence "sandwich" immunoassay method. The plasma Apelin-12 level was determined by Enzyme linked immunosorbent assay in all the subjects. We analysed the correlation between NT-proBNP and Apelin-12 in the three different clinical types of groups.49 patients with acute coronary syndrome (ACS, including UAP and AMI) were carried out coronary arteriongraphy and percutaneous coronary intervention (PCI):UAP group 21 cases, AMI group 28 cases. Baseline clinical data of the two groups was no significant difference (P>0.05). We used Gensini scoring system to integrate the degree of coronary artery disease, then analyzed the correlation between plasma NT-proBNP, Apelin-12 level and Gensini scores. At the same time, we detected plasma NT-proBNP, Apelin-12 level of the part of patients for a week after PCI, and compared of the level of both before and after PCI.Results1. The plasma NT-proBNP levels were difference in three clinical types. The plasma NT-proBNP levels were 208.67±61.35pg/ml in SAP group,404.99±108.30pg/ml in UAP group and 404.99±108.30pg/ml in AMI group respectively. These were higher than control group which was (78.67±13.34)pg/ml (P<0.05). Statistically difference was existed between each group (P<0.05).2. The plasma Apelin-12 levels in patients with coronary heart disease were lower in all clinical types, each group and the control group (3.06±0.28ng/ml) was statistically significant (P<0.05). In the SAP group of its low levels (2.35±0.20ng/ml), in the UAP group lower (1.72±0.23ng/ml), the lowest in the AMI group (0.97±0.24)ng/ml, between each two groups was significant difference (P<0.05).3. There were negative correlation with plasma NT-proBNP and Apelin-12 in coronary group (r=-0.834, P<0.05), SAP group (r=-0.428, P<0.05), UAP group (r=-0.509, P<0.05) and AMI group (r=-0.488, P<0.05).4. The plasma NT-proBNP positively correlated with the Gensini score in UAP group (r=0.715, P<0.05) and AMI group (r=0.751, P<0.05). But the plasma Apelin-12 had a negative correlation with the Gensini score in the two groups (r= -0.448, P<0.05 in UAP group, r=-0.464, P<0.05 in AMI group respectively).5. The NT-proBNP plasma levels were 106.74±28.10pg/ml in UAP group and 136.65±51.76pg/ml in AMI group respectively in ACS after PCI. These were decreased the NT-proBNP plasma levels compared with preoperative levels (421.95±99.14pg/ml in UAP group,578.50±141.84pg/ml in AMI group respectively, P<0.05). The plasma Apelin-12 levels were 2.61±0.21 ng/ml in UAP group,2.38±0.22ng/ml in AMI group respectively in ACS after PCI. These were increased the palsma Apelin-12 levels compared with preoperative levels (1.72±0.28ng/ml in UAP group,1.00±0.23ng/ml in AMI group respectively, P <0.05).Conclusions1. The plasma NT-proBNP levels increased with the severity of the clinical types in patients with coronary heart disease, but Apelin-12 levels decreased in these patients, and the plasma NT-proBNP had a negative correlation with Apelin-12.2. The plasma NT-proBNP positively correlated with the Gensini score which can reflect the severity of coronary artery disease in patients with ACS, but Apelin-12 had a negative correlation with the Gensini score.3. The plasma NT-proBNP levels reduced greatly after PCI in patients with ACS, but Apelin-12 levels showed the opposite change.
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