| Background and ObjectiveCoronary heart disease (CHD) is caused by atherosclerosis of coronary artery, which obstructs lumen and leads to myocardial ischemia and hypoxia. With the high rate of incidence and mortality, CHD is one of the major cardiovascular diseases that damages severely human health. Many studies on CHD pathogenesis have been carried on since 1970s, which explain presence of coronary atherosclerosis on different emphasis. Now it is definite that multiple bioactive molecules were involved in the injury of vascular endothelial cells, proliferation and migration of smooth muscle cells and hyperplasia of fibroblasts. More knowledge about these bioactive molecules in CHD contributes to make clear the process of pathophysiology of CHD and to provide theoretic and experimental evidences for clinical application in CHD.Adrenomedullin (ADM) is a novel vasoactive peptide originally isolated from human pheochromocytoma tissue in 1990s, with the biological effect of vasodilation, inhibition of vascular smooth muscle cells proliferation, natriuresis, diuresis, attenuation of inflammatory reaction, etc. ADM closely relates to the diseases such as hypertension and congestive heart failure, as an endocrine factor involved in the process of these diseases. The relationship between ADM and CHD is uncertain, theoretically, through inhibiting the proliferation and migration of vascular smooth muscle cells, preventing the apoptosis of endothelial cells and anti-inflammation, ADM may stop atherosclerosis. Recent years it has been reported that highly bioactive ADM exsited in CHD animals and ADM gene overexpressed in the endothelial tissue of CHD animals, meanwhile, plasma level of ADM is higher in CHD patients compared with that in non-CHD patients, for these reasons ADM has certain relation to the occurrence and development of CHD. However, medical researchers know very little about the association among plasma ADM, types of CHD and numbers of stenosed coronary vessel, so we make this clinic study in order to explore the relationship between ADM and CHD further.MethodsA total number of 182 in-patients suffering chest pain from Aug.2008 to Oct. 2009 in cardiology department were recruited in this studied.142 subjects undergone coronary angiography (CAG) were diagnosed CHD (with≥50% stenosis in at least one of the three coronary vessels), who separated into three groups according to clinical feature, electrocardiogram and serum markers:36 patients with stable angina pectoris (SAP),60 patients with unstable angina pectoris (UAP) and 46 patients with acute mycardial infarction (AMI). All CHD cases were angiographically divided into single-vessel, double-vessel and triple-vessel group. The other 40 subjects without stenosis in all the three coronary vessels, having neither hypertension, heart failure, pulmonary disease nor tumor, were considered as controls. The concentration of plasma ADM were measured by enzyme-linked immuno sorbent assay (ELISA). The ADM levels among different groups were compared and the statistic work was carried out with software of SPSS13.0, a value of P<0.05 was considered statistically significant.Results1 There was no statistic significance in the gender ratio, blood pressure and heart function among the SAP group, UAP group and AMI group (P>0.05).2 The mean plasma ADM concentration of the controls was (7.73±2.14) ng/ml, which of the CHD was (14.61±5.56) ng/ml, respectively, the SAP group, UAP group and AMI group was (7.60±2.07) ng/ml, (14.29±2.71) ng/ml and (20.50±2.97) ng/ml. The plasma ADM was significantly higher in CHD than in controls (P<0.05).3 One-way analysis of variance showed the statistic difference among the control group, SAP group, UAP group and AMI group (P<0.05). Multiple comparison:any group was statistically different from the other three groups (P<0.05), besides the SAP group from the control group (/>0.05). The AMI had the highest ADM level, and the UAP followed.4 The mean concentration in CHD patients with hypertension (58 cases of the 142,40.8%) was significantly higher compared with that in CHD patients without hypertension (84 cases of the 142,59.2%) [(16.25±5.34) ng/ml versus (13.47±5.44) ng/ml, P<0.05].5 The mean level in CHD patients with heart failure (46 cases of the 142,32.4%) was significantly higher compared with that in CHD patients without heart failure (96 cases of the 142,67.6%) [(16.67±5.75) ng/ml versus(13.62±5.21) ng/ml, P<0.05].6 39 cases with single-vessel disease (27.5%)71 cases with double-vessel disease (50.0%),32 cases with triple-vessel disease (22.5%), ADM level of the three groups was respectively (14.00±5.20) ng/ml, (14.81±5.92) ng/ml and (14.89±5.24) ng/ml, with no statistic significance among them (P>0.05).Conclusions1 ADM level is elevated in patients with CHD. ADM may be involved in the process of pathophysiology of CHD.2 ADM level in AMI patients and UAP patients is higher than in SAP patients, AMI is highest and UAP follows, SAP shows no difference from normal person. ADM is related to the vulnerability of atherosclerotic plaque.3 ADM level in CHD with either hypertension or heart failure is higher compared with that in CHD with neither hypertension nor heart failure. ADM is helpful to evaluate CHD complexity.4 ADM level has no significant difference among single-vessel, double-vessel and triple-vessel. ADM indicates no association with the number of stenosed coronary vessel.
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