The Study Of Clinical Risk Factors And Plasma Inflammatory Factors In Coronary Slow Flow Phenomenon

Objective: Explore the clinical risk factors of coronary slow flow phenomenon(CSFP)and the relationship with coronary artery morphological parameters,identify the relationship between CSFP and inflammation,endothelial injury and platelet activation,and search for novel plasma markers with diagnostic value.Method: This study was divided into two stages.All the subjects were from hospitalized cases in the heart center of the first hospital of lanzhou university from 2017 to 2019.The clinical data of the subjects were from the medical records after admission,and the laboratory data were from the heart center laboratory.Using a case-control study.The first stage: CSFP clinical risk factors and the correlation between CSFP and morphology were studied.That is,to explore the clinical laboratory test indicators that can predict the CSFP,and to clarify the relationship between coronary artery morphological parameters and coronary TIMI blood flow.This part included 100 CSFP patients(experimental group)and 156 patients with normal coronary angiography(control group).All subjects had angiographically confirmed normal coronary arteries,and CSFP was diagnosed by the number of frames of the thrombolytic test(TIMI)for myocardial infarction.General data,laboratory test indicators,echocardiography and coronary angiography data of the two groups subjects were collected.Statistical analysis.First,check the data integrity and normal distribution.t test or chi-square test was used to compare the differences between the two groups in general data,laboratory test indexes,echocardiography and coronary artery morphology parameters.After that,the correlation between the single factor and the coronary TFC was analyzed to find the relevant factors affecting the coronary blood flow.The binary Logistic regression model was used to find the independent risk factors for predicting CSFP in laboratory tests.Part stage: Combined with the results of the first stage study,to explore the association between CSFP and plasma inflammation,endothelial injury,and several platelet activation to find new plasma markers that predict CSFP.To clarify the association between CSFP and inflammation,endothelial injury and platelet activation by comparing the differences between plasma inflammatory factors(S100A9 ?hs-CRP),endothelial injury factors(Endostatin)and platelet activating factors(SP-selection)in the CSFP and normal control groups.Finally,multivariate regression was performed to obtain novel plasma markers with significant predictive value for CSFP.For this part,we included 38 CSFP patients and 38 normal coronary angiography patients.Blood sample collection: before coronary angiography,the arterial blood was extracted through the radial or femoral artery for 15 ml,after centrifugation,and the plasma was frozen for-80 ? reserve.Elisa possible pathophysiological mechanisms of the CSFP were estimated by measuring plasma S100A9?hs-CRP?Endostatin and SP selectin levels in combination with laboratory test indicators.Statistical analysis,First of all,the t test or chi-square test to compare the differences between groups of single factors,the single factor comparison has significant differences in indicators with binary Logistic regression model fitting,looking for independent risk factors to predict CSFP.And then the correlation between plasma markers and coronary TFC and coronary artery morphological parameters was analyzed.The independent risk factor was used as the work characteristic curve(ROC curve)to judge the diagnostic value of the CSFP by the area under the curve(AUC),and the cut-off value,sensitivity and specificity of the were calculated.Results:The results of the first stage :(1)the number of TIMI blood flow frames(cTFC)and the number of TIMI blood flow frames(Ave-cTFC)corrected by three coronary arteries in the CSFP group were>27 frames,which met the CSFP diagnostic criteria and were significantly higher than those in the control group(P<0.05).(2)Triglyceride,homocysteine,neutrophil percentage,lymphocyte percentage,mean platelet volume(MPV)and platelet distribution width(PWD)increased significantly in the CSFP group compared to the control group(P<0.05).(3)Lower intraoperative blood pressure in the CSFP group(P<0.05).The left coronary artery main stem diameter(LM-d),left anterior descending proximal segment diameter(LADp-d),left anterior descending middle segment diameter(LADm-d),left circumflex artery proximal segment diameter(LCXp-d),left circumflex artery middle segment diameter(LCXm-d),right coronary proximal segment diameter(RCAp-d),right coronary middle segment diameter(RCAm-d),coronary proximal segment average diameter(Avep-d),coronary middle segment average diameter(Avem-d),coronary artery average diameter(Ave-d)were all larger(P<0.05).The number of distal branches of the left anterior descending(LAD-NDB),the number of distal branches of the left circumflex artery(LCX-NDB),the number of distal branches of the right coronary(RCA-NDB)and the average distal branch(Ave-NDB)were all lower than those of the control group(P<0.05).(4)Correlation analysis revealed a significant positive correlation between coronary Avep-d?Avem-d?Ave-d and Ave-cTFC,with correlation coefficients(r=0.570,0.506,0.583,P<0.05),and a significant negative correlation between coronary Ave-NDB and Ave-cTFC(r=-0.508,P<0.05).The percentage of neutrophils was positively correlated with the average cTFC of coronary artery and coronary artery diameter(r=0.340,0.335,P<0.05).? The independent risk factors of CSFP through a bivariate Logistic regression model to analysis.Finally,we found that Homocysteine(OR=1.077,95%CI:1.034~1.123,P < 0.05),percentage of neutrophils(OR=1.064,95%CI:1.032~1.097,P < 0.05),platelet distribution width(OR=1.194,95%CI:1.051~1.356,P < 0.05)and mean platelet volume(OR=1.338,95%CI:1.127~1.588,P<0.05)were independent risk factors for predicting CSFP.The results of the second stage : ?t test between the two groups showed that the plasma homocysteine,mean platelet volume and S100A9?hs-CRP?Endstatin in CSFP group were higher than those in control group(P<0.05),and fibrinogen was lower than that in control group(P<0.05).? Correlation analysis have found that plasma S100A9,hs-CRP and Endotatin was positively correlated with mean coronary cTFC(r=0.441,0.343,0.426,P<0.05),and positively correlated with mean coronary diameter(r=0.356,0.417,0.356,P<0.05).Endotatin had no correlation with the number of distal vascular branches.The mean coronary cTFC was positively correlated with mean coronary diameter(r=0.671,P<0.05),and negatively correlated with the number of branches of distal coronary artery(r=-0.523,P<0.05).hs-CRP were positively correlated with S100A9(r=0.420,P<0.05).?Binary Logistic regression model have showed that S100A9(OR=1.194,95%CI:1.049~1.358,P<0.05)and hs-CRP(OR=1.817,95%CI:1.032~3.630,P<0.05)were independent predictors of CSFP occurrence.? Use the hs-CRP?S100A9 and hs-CRP+S100A9 combined indicators as test variables to do researchers' work characteristic curves which evaluate the diagnostic value of CSFP.When the cut-off value of the hs-CRP was 1.24 mg/L,the Youden index was the largest,the corresponding sensitivity was 68.4%,the specificity was 73.7%,and the area under the curve was 0.764(P<0.001).When the cut off value of the S100A9 was 16.57 ng/ml,the Youden index was the largest,the corresponding sensitivity was 52.6%,the specificity was 81.6%,and the area under the curve was 0.743(P<0.001).When hs-CRP+S100A9 was used as a joint index,the corresponding sensitivity was 84.2%,the specificity was 73.7%,and the area under the curve was 0.856(P<0.001).Conclusion:First,Neutrophil percentage,homocysteine,platelet distribution width and mean platelet volume were clinical indicators for predicting CSPF.Second,increased coronary artery diameter and decreased distal branch number were significantly associated with decreased coronary TIMI flow.Third,plasma S100A9 and hs-CRP were independent predictors of CSFP,and were significant positively correlated with the average coronary TFC.The combination of the two biomarkers can improve the ability of diagnostic CSFP.Inflammation may be involved in CSFP.