| BACKGROUNDCoronary atherosclerotic heart disease is a common clinical cardiovascular disease, a serious hazard to human health. Coronary atherosclerotic heart disease refers to coronary stenosis or obstruction caused by atherosclerosis, it leads to myocardial ischemia and hypoxia. Coronary atherosclerotic heart disease together with coronary functional changes(coronary artery spasm) are collectively referred to coronary heart disease(CHD). Coronary heart disease is a public health problem of global concern. Its rising incidence forced many developed and developing countries to pay more attention to it and put a lot of medical resources and public expenditure on it. According to the statistics of American Heart Association, there are about610,000cases of myocardial infarction events and325,000cases of recurrent cardiovascular events in the United States each year. There is an American suffering coronary event per second, while almost one died of adverse cardiovascular events every minute. Arginine vasopressin (AVP) is a neuroendocrine media in the development and progression of cardiovascular disease and it is the key mediator of sodium and water retention. The half-life of plasma AVP is very short, only10～30min, what makes its plasma determination difficult.In recent years, it was found that the vasopressin original (pre-provasopressin) consists of three parts active fragment, the AVP (pre-provasopressin20～28), copeptin (pre-provasopressin126～164) and Neurophysin II (pre-provasopressin32～124), of which copeptin is more stable in the body and easy to determine.Copeptin and AVP in the normal population and patients with a variety of cardiovascular diseases showed a significant positive correlation. So copeptin is expected to be a clinical warning marker for these diseases.OBJECTIVETo analyze the correlation between serum level of copeptin and different CHD types, heart function classifications, and the severity of coronary artery lesions by determinating serum copeptin level in patients with CHD. Then investigate whether copeptin can be used as a serum marker of coronary heart disease.METHODSThe serum copeptin level was determined by ELISA in266patients with CHD and50healthy controls(control group), meanwhile the serum level of blood lipid, blood glucose, fibrinogen(FIB) were determined by automatic biochemical analyzer. Then the relationships between serum copeptin level and different CHD types, heart function classifications, the severity of coronary stenosis were analyed.RESULTS(1) The serum level of TC(total cholesterol), TG(total triglyceride), LDL-C(low-density lipoprotein cholesterol), FPG(fasting plasma glucose), FIB(fibrinogen) and copeptin were significantly higher in CHD group than that in control group (P<0.01), while the serum level of HDL-C was significantly lower than that in control group(P<0.01).(2)Grouped according to different CHD clinical types, the serum level of copeptin gradually increased in SAP, UAP, AMI, ICM group, those of AMI, ICM group were higher than in SAP, UAP group (P<0.01或P<0.05), but there were no statistical differences between SAP and UAP group (P>0.05).(3)Grouped according to lesion vessels in CHD patients(those who underwent coronary angiography). Serum level of copeptin increased continually with lesion vessels, that of3branch lesion group was higher than that of the1branch and the2branch lesion group (P<0.01or P<0.05). Correlation analysis showed that the serum copeptin were significantly positively with the levels of TC, TG, LDL-C and the coronary artery score (respectively r=0.226,0.275,0.259,0.595, P<0.01), while positively correlated with the levels of FPG、FIB(r=0.218、0.201, P<0.05), but without significant correlation with HDL-C (P>0.05). (4) Grouped according to NYHA classification in CHD patients (those who underwent echocardiography). Copeptin in class4was significantly higher than that of class1,2,3(P<0.01), that of class3was higher than in class2(P<0.05). Correlation analysis showed that the serum copeptin was significantly positively with the levels of LAD, LVEDd and BNP (respectively r=0.350,0.474,0.447, P<0.01), while negatively correlated with levels of IVS, LVEF((respectively r=-0.184,-0.633, P<0.05or P<0.01), but without significant correlation with LVPW(P>0.05).(5) The sensitivity and specificity of copeptin, CTNI and BNP in AMI diagnosis were respectively95.3%and52.3%,89.1%and93.5%,90.6%and89%, while the area under the ROC curve (AUC) were0.808(95%confidence interval:0.750-0.866),0.963(95%confidence interval:0.938-0.988),0.916(95%confidence interval:0.875-0.958). Joint detection of the three indicators using logistic regression and ROC curve analysis, only CTNI and Copeptin were included in the regression equation. Combined detection of CTNI and Copeptin in the diagnosis of AMI, sensitivity and specificity were respectively85.9%,88.4%.CONCLUSIONThe serum level of copeptin increased with coronary artery disease progress, deterioration of cardiac function. It can reflect the extent of the coronary lesion in patients with CHD, moreover, it is stable, easy to determine in vivo. So it can provide important value in CHD prognosis and severity assessment. |
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