| Background and purpose It is first reported by Tambe’in1972that some patients with chest pain have not found the main coronary lumen obviously stenosis during coronary angiography, however, their main coronary lumen has significantly slowed-down blood, such phenomenon is defined as Coronary Slow Flow Phenomenon. CSFP refers to the phenomenon that patients with chest pain or chest tightness, who has coronary thrombolytic therapy, coronary angioplasty, coronary spasm or expansion, coronary gas embolism, cardiomyopathy, connective tissue disease, hyperthyroidism and heart valve disease that may lead the coronary blood flow velocity to slow down was excluded, have delayed progression of the contrast medium in the absence of significant epicardial coronary disease during coronary angiography. Blood flow velocity is an important indicator of myocardial perfusion Ischemia.With the popularity of coronary angiography and the enhancement of its increasing value in the diagnosis of coronary heart disease,CSFP detection rate is increasing continuously about7%2, patients with CSFP often have repeated episodes of chest pain or chest tightness that can not be explained by other diseases. The probability of occurrence of acute coronary syndrome, arrhythmia, even sudden death, serious cardiovascular disease increased significantly compared with normal coronary flow in the long term. But the exact mechanisms of how the slowing down of the coronary blood flow can affect myocardial perfusion and the progression for serious cardiovascular disease is not yet clear. At present, many clinicians have not paid enough attention to the CSFP and can not combine recurrent chest pain, chest tightness with the CSFP, leading to inadequate understanding the cause of coronary circulation disorders, which affects the patient’s condition adversely.It is traditionally believed that the CSFP results from microvascular dysfunction, but some scholars believe that the CSFP is the early stage of coronary atherosclerosis, and it will eventually develop into the coronary atherosclerosis, some scholars believe that it is related to the abnormal metabolism of vascular endothelial and the other doctrines of the vasomotor factor secretion disorders and the abnormal platelet function.Recently,Turhans3and colleagues suggested that the expression of the inflammatory factors such as intracellular adhesion moleculel1(ICAM-1), vascular cell adhesion molecule1(VCAM-1), E-selectin, high homocysteine(Hcy),C-reactive protein(CRP), Interleukin6(IL-6) in CSFP patients increased. It has been reported that inflammation is the main pathogenesis of many cardiovascular diseases and is associated with various types of clinical coronary disease. The role of inflammation in particular atherosclerosis has been confirmed by most scholars. But few studies investigate the correlationship between CSFP and coronary vascular inflammation. Adiponectin is the protein hormone secreted by fat cells, which is the only negative regulator of hormone that has been found at present. By increasing insulin sensitivity, anti-inflammatory, anti-artery atherosclerosis, Adiponectin affects the cardiac muscle, smooth muscle and endothelial cell function and plays an important role in the incidence and development of diabetes, lipid metabolism and inflammatory responses, and it is an important sensitive indicator of inflammatory response. High sensitivity C-reactive protein reflects a variety of acute and chronic inflammation and plays an important role in starting complement regulation. The interleukin-6(IL-6), interleukin-1(IL-1), tumor necrosis factor-2(TNF-2) produced by the initial macrophages and neutrophils are involved in inflammation, it is the most common clinical acute phase protein at present. The study aims to investigating the correlation between CSFP and serum APN, Hs-CRP levels and investigate the role of vascular inflammation in the CSFP process.Method Select80cases that coronary angiographily showed no significant stenosis of epicardial coronary artery in Jining Medical College Affiliated Hospital from January2010to April2011,41males and39females, all of the selected patients who were clinically diagnosed as coronary heart disease or myocardial ischemia are recurring chest tightness or chest pain, for whom drug treatment is ineffective and electrocardiogram showed ST-T changes that can not be explained by other diseases. If patients showed no significant coronary artery disease after left and right coronary angiography by the udkins catheter, then we adjusted thrombolysis in myocardial infarction flow frame count to record coronary blood flow frames, and calculated the average number of frames of coronary blood flow, and defined the average number of frames of coronary blood flow greater than27as coronary slow flow. Patients were divided into CSFP group of35cases and normal coronary flow group of45cases. Both groups have no significant differences in the age, sex, history of hypertension, history of diabetes, BMI(P>0.05). Collected fasting venous blood5ml, placed it in a test tube of biochemical, and quickly put it into the centrifuge, separate serum at3000/Per-minute for15minutes. Put the serum samples in freezer refrigerator stored at-80℃to be tested.Use the ELISA method (Enzyme-linked immunosorbent assay ELISA) to test serum APN, Hs-CRP levels,use SPSS13.0software for windows statistical software for statistical analysis, P<0.05was considered statistically significant.Result1. Both groups have no significant differences in the sex, age, history of smoking, history of hypertension, history of drinking, history of diabetes,the level of fasting plasma glucose,liver function (P>0.05).2. Serum APN level of CSFP patients was significantly lower than the control group [(9.15±1.36) μg/ml VS (4.80±1.06)μg/ml, P<0.001]; Serum Hs-CRP level of CSFP were significantly higher [(4.14±0.89) μg/ml VS (1.45±0.57)μg/ml, P<0.001].3. The Serum APN of CSFP patients and Hs-CRP level was negatively correlated (r=-0.77, P=0.000).4. coronary blood flow frames was negatively correlated with the level of Serum APN(r=-0.39, P=0.000) and was positively related to the level of Hs-CRP(r=0.51, P=0.000)5. Hs-CRP is a risk factor that affect CSFP (OR=5.84, P=0.03) and APN is the protection factor of CSFP (OR=0.24,P=0.04).Conclusion1.APN level in CSFP patients was lower than the NCF group, and Hs-CRP levels were significantly higher than the NCF group.2. Coronary blood flow frames was negatively correlated with the level of Serum APN and was positively related to the level of Hs-CRP. Hs-CRP is the risk factor of CSFP and APN is the protection factors of CSFP.3. The coronary vascular inflammation plays an important role in the pathophysiological process of CSFP. |
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