FGF21 And Insulin Resistance Associated With Severity Of Coronary Artery Disease

Objective:Coronary heart disease(CHD)is the leading cause of death from cardiovascular disease worldwide,which has brought a huge economic burden to society.The aim of this study was to observe the level of plasma fibroblast growth factor 21(FGF21)and insulin resistance(IR)in patients with different severity of coronary artery stenosis.At the same time,we studied the association between FGF21,IR and the Gensini score(GS),so as to explore its role in predicting the severity of coronary artery stenosis,and to provide a basis for subsequent clinical intervention,diagnosis and treatment for coronary artery disease.Methods:Between May 2019 and October 2019,a total of 136 subjects visiting the Northern Jiangsu People's Hospital for examination by coronary arteriography due to chest pain or chest tightness were recruited for this study,and the final study subjects were determined according to the inclusion and exclusion criteria.All of them signed informed consent and underwent coronary angiography(CAG)examination.According to the results of coronary angiography,they were divided into CHD group(n=95)and non-CHD group(n=41).All subjects were scored by the Gensini scoring system,which was used to assess the severity of coronary artery stenosis.According to the tertile interval of Gensini score,the subjects in the CHD group were divided into low group(n=33),medium group(n=3 1)and high group(n=31).All clinical data at baseline were collected,including demographic characteristics,laboratory data,left ventricular ejection fraction and coronary angiography.The concentrations of FGF21 and insulin in fasting plasma were detected by Enzyme-linked immunosorbent assays(ELISA),and homeostasis model assessment of insulin resistance index(HOMA-IR)was further used to quantify insulin resistance.EXCEL,SPSS 22.0,GraphPad Prism 5.0,and MedCalc were used for analysis of the differences among each group.Regression analysis was conducted on the factors which affected FGF21,HOMA-IR and severity of coronary artery stenosis.Receiver operating characteristic curve(ROC)was used to analyze the efficiency of FGF21,HOMA-IR and their combined prediction of coronary heart disease.Results:1.CHD group and non-CHD group in gender,smoking,WBC,NE,BUN,Cre,UA,Lp-a,FBG,LVEF,INS,FGF21,HOMA-IR were significantly different(P<0.05)There was no statistically significant difference in age,BMI,SBP,DBP,HR,history of hypertension,history of cerebral infarction,LY,MONO,ALT,eGFR,TG,TC,AST,HDL-C,LDL-C,Apo Al and Apo B(P>0.05).Comparison between groups showed that the levels of FGF21 and HOMA-IR were significantly different between high group and non-CHD group,high group and low group,medium group and non-CHD group(P<0.05),while the differences between the other groups were not statistically significant(P>0.05)2.The Spearman correlation analysis showed that male,smoking,ALT,AST,INS,FGF21,HOMA-IR were positively related with Gensini scores(P<0.05).LY,Apo Al,LVEF were negatively correlated with Gensini scores(P<0.05).Age,BMI,SBP,WBC,NE,MONO,BUN,Cre,UA,eGFR,TG,TC,HDL-C,LDL-C,Apo B,FBG had no correlation with Gensini scores(P>0.05).3.Regression analysis was conducted on the factors affecting FGF21 and HOMA-IR levels,respectively.It was found that smoking and Gensini score were independent predictors of FGF21,and Gensini score was independent predictor of HOMA-IR(P<0.05)4.Logstic regression analysis results showed that TC,Lp-a,FGF21 and HOMA-IR were independent risk factors for CHD.HDL-C was independent protective factor for CHD.All of them have statistical differences(P<0.05).FGF21 and HOMA-IR were independent predictors for the severity of coronary artery stenosis(P<0.05).5.The ROC curve suggested that when the cut-off value of FGF21 was 165.41pg/mL and HOMA-IR was 1.15,the diagnostic efficiency was the highest.The area under the ROC curve(AUC)was 0.738 and 0.710(P<0.01),respectively.The diagnostic efficiency was the highest when the two were combined detection,and AUC was 0.762(P<0.01).But there was no statistical difference between them(P>0.05).The AUC value of both individual and combined detection were between 0.7 and 0.9,indicating that the test methods had certain accuracy.Conclusions:1.Plasma FGF21 level and IR significantly increased in patients with coronary artery disease,which were positively correlated with the severity of coronary artery stenosis2.FGF21 and IR were independent predictors of coronary artery disease and have good predictive value for the severity of coronary artery stenosis3.Whether FGF21 and IR can be used as targets for drug treatment of coronary heart disease was an important research direction in the future.