| BackgroundCoronary heart disease is a common and frequently-occurring disease which threat the human health seriously and whose the most common clinical type is acute coronary syndrome, the characteristics of ACS include the acute onset, the condition changes quickly and the fatality rate is high. The full name of the coronary heart disease is coronary atherosclerotic heart disease, which indicate that coronary atherosclerosis make the vascular stenosis or obstruction, or (and) the heart disease is caused by myocardial ischemia and hypoxiaor necrosis which were lead by coronary functional changes, all of them are collectively referred to as coronary heart disease (CHD), also known as ischemic heart disease. Coronary heart disease accounted for about two-thirds of all cardiovascular disease hospital admission, which has a high incidence, involving wide groups and prognosis differently. It has an important significance to patients and clinicians on how to diagnosis coronary heart disease, especially ACS, early and correctly in clicical in order to determine treatment options, prevent complications and assess prognostic of coronary artery disease. The study found that, excepting the equipment inspection and coronary angiography, the biomarkers which is generated in the acute phase of ACS, and expressed in the blood,also play an imporment role in early diagnosis and the risk stratification of the disease.It is recognized currently that troponin is one of the most valuable biomarkers of ACS which can assessment condition of disease. Biomarkers can reflect the changes of the disease, and it is independence, classificate and continuous with the disease.With the rapid development of molecular biology and cell biology, new biomarkers are emerging. The American Heart Association (AHA) published the evaluation criteria of the new markers in2009, which helps the application of biomarkers, also point that a valuable biomarkers play an important role in the diagnosis of disease. Therefore it is claimed that finding objective, accurate, simple and inexpensive indicators to guide the diagnosis and treatment of coronary heart disease is in clinical work.Recent studies have found that follistatin-like protein1(follistatin-like protein1, FSTL-1) is a308amino acid sequence secreted extracellular matrix glycoprotein[3], which also is known as clone36that is stimulated by transforming growth factor-beta [2]. FSTL-1is a cytokine secreted by myocardial cells,expressing in myocardial ischemic injury and cardiac pressure overload, and also highly expressed in the inflammatory immune, oxidative stress, cell proliferation and migration, immune response, revascularization, anti-apoptotic and so on [4]. Currently,it might be a more promising predictive of myocardial damage serum marker[5].But the relationship of the expression level between FSTL-1and cardiac troponin and N-terminal pro-B-type natriuretic peptide in different types of patients with coronary heart disease, especially in patients with ACS has not to been explored. In addition, the relationship of the FSTL-1level of serum and the degree of coronary artery stenosis has not been reported. Therefore, the experiment is about to explore the relationship between the FSTL-1levels of serum and cTnT, NT-proBNP, the severity of coronary artery disease, by observing serum of FSTL-1levels with CHD patients, in order to provide a basis for that FSTL-1may be a serum markers of ACS.MethodsA total of308patients suspected diagnosis with coronary artery disease, all of those patients was bring in the Cardiology Department of our hospital from September2011to January2012.all of the patients undergoing coronary angiography and according to coronary angiography results divided into:coronary heart disease group258examples (male157and female101patients, average age63.65±6.52);50cases belong to control group(male28and female22patients, average age55.23±7.21). Coronary heart disease groups according to history and electrocardiogram into stable angina pectoris group53examples (male25and female28patients, average age61.27±7.65);205cases belong to ACS group(male132and female73patients, average age (64.79±5.72).ACS group according to the ACC/AHA diagnostic criteria into three groups:,high-risk group77cases, the medium-risk group69cases., the low-risk group59cases. All of the patients records include age,gender, height, weight,resoures,and presence of high blood pressure,diabetes,myocardial infarction history and smoking history and so on; After check-in hospital the next morning extraction venous blood fasting for12hours, collect glycosylated hemoglobin(HbAIc), total cholesterol (TC),triglyceride (TG), high density lipoprotein-Cholesterol (HDL-C), low density lipoprotein-Cholesterol (LDL-C),blood usea nitrogen(BUN),creatinie (Cr) biochemical index, both by the specialist laboratory quality inspection. Serum level of FSTL-1was measured by Enzyme Linked Immunosorbent Assay(ELISA), coronary lesions by Gensini integral result. The correlation analysis was made between the serum level of FSTL-1and cTnT, NT-proBNP, Gensini integral and LVEF respectively in ACS group and among ACS group. Receiver operating characteristic (ROC) cure was used to analyse FSTL-1level to determine the best cut poit.Result1. The general clinical features of the research object:there is not significant on the gender,age, body mass index(BMI), total cholesterol (TG),triglyceride (TC), high density lipoprotein-Cholesterol (HDL-C), glycosylated hemoglobin(HbAIc), blood usea nitrogen(BUN),creatinie(Cr) biochemical index between the CAD group and the control group and also among the three further group of ACS (P>0.05) 2. Comparison serum level of FSTL-1:serum level of FSTL-1in the CAD group (18.25±5.53) raised singnificantly than the control group(5.55±1.53)(P<0.01); Serum level of FSTL-1in the ACS group (28.49±4.27) raised singnificantly than the SAP group (12.49±4.28) and the control group (5.55±1.53)(P<0.01).3.Comparison among three subgroups of ACS:FSTL-1levels in the high-risk group were significantly increased than the medium-risk group(P<0.01) cTnT, NT-proBNP and Gensini points score(P<0.01); FSTL-1levels in the medium-risk group were raised significantly than the low-risk group(P<0.01) cTnT, NT-proBNP and Gensini points score(P<0.01). With risk stratification increased, cTnT, NT-proBNP and Gensini points score gradually increased(P<0.01, P<0.05)and LVEF gradually decline (P<0.05).4.The correlation analysia shows:FSTL-1levels was correlated positively with cTnT,NT-proBNP and coronary angiography Gensini points (r=0.660,0.690,0.756, P<0.01) and was correlated negatively with LVEF (r=-0.761, P<0.01) with the high-risk group of ACS.With the rise of rick stratification, the absolute values of r values between serum FSTL-1levels and Gensini points score are gradually increasing among three subgroup of ACS group(r values for the high-risk group, medium-risk group, low-risk group are respectively0.756、0.699、0.352P<0.01P <0.01P<0.05.5. The ROC cure analysis of FSTL-1levels diagnosising ACS:area under the curve of FSTL-1levels was0.846(95%CI:0.794-0.898P<0.01),sensitivity was86.7%, specificity79.9%,the best diagnostic cutpoints to16.9ug/L.Conclusion1. Serum level of FSTL-1is significantly raised in the patients with CHD, which is more obviously elevated in patients with ACS, and it is significantly positively correlated with cTnT concentration.2. Serum level of FSTL-1is significantly raised in the patients with ACS, and it is significantly positively correlated with NT-proBNP concentration.3.The level of FSTL-1in the patients with ACS is raised, which is significantly correlated with severity of coronary artery stenosis.4.FSTL-1may be a new biomarkers for assessment of myocardial injury and severity of coronary artery stenosis with ACS. |
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