184 Journal of Hainan Medical University 2016; 22(16): 184-188 Journal of Hainan Medical University http://www.hnykdxxb.com/ The changes of serum BDNF, blood lipid and PCI in the elderly patients with coronary heart disease complicated with diabetes mellitus Chun-Xia He 1, Jing-Jing Yang 2, Mei-Jin Yuan 1, Xiao-Juan Ding 1 1 First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei 2 Second Affiliated Hospital of Hebei North University, Zhangjiakou 07500, Hebei ARTICLE INFO Article history: Received 2 Jun 2016 Received in revised form 21 Jun 2016 Accepted 7 Jul 2016 Available online 24 Jul 2016 Keywords: Old age Coronary heart disease Diabetes mellitus Brain derived neurotrophic factor Blood lipid ABSTRACT Objective: To compare the clinic from coronary heart disease complicated with diabetes mellitus patients serum BDNF changes, blood tests and PCI, for the clinical treatment of coronary heart disease in patients with diabetes mellitus provide certain reference and ideas. Methods: In outpatient of our hospital of elderly patients with coronary heart disease in patients with diabetes mellitus complicated with 126 cases into coronary heart disease combined with diabetes mellitus group, CHD patients admitted in the same period of 125 cases into coronary heart disease group and healthy subjects during the same period in 120 cases into the healthy control group, 61 males, 59 females, aged 58 to 79 years old, mean age (64.36 依 2.20) to exclude coronary heart disease, diabetes and liver and other diseases. All patients according to Gensini integration system and coronary artery vascular image segmentation evaluation criteria for each of the degree of vascular stenosis were evaluated. Total cholesterol (TC), glycerin three fat (TG), low density protein (LDL-C), high density protein (HDL-C), apolipoprotein A1 (APOA-1) and apolipoprotein B (APOB) and other indicators were detected. The number of stents, mean diameter and length of stent in patients with coronary heart disease combined with diabetes mellitus and coronary heart disease group were compared. Results: Coronary heart disease with diabetes mellitus group Gensini score and serum BDNF concentrations were higher in CHD group and control group, CHD group Gensini score and serum BDNF concentrations were significantly higher than the control group, the differences were statistically significant; coronary heart disease and coronary heart disease group and blood fat group in TC, TG, LDL-C, diabetes, APO-B levels were significantly higher than that of control group HDL-C and APOA-1 were significantly lower than control group, coronary heart disease and diabetes group in TC, TG, LDL-C, blood lipid and APO-B level were significantly higher in CHD group, the differences were statistically significant; the number and length of coronary heart disease in diabetic group were higher than that of the stent stent in coronary heart disease group, average diameter less than coronary heart disease group differences were statistically significant. Conclusion: the coronary heart disease patients with diabetes mellitus in serum brain-derived neurotrophic factor (BDNF) and coronary artery stenosis has certain correlation, clinical should strengthen the blood lipid and other related indicators detection, combined with other auxiliary examination, in order to reduce the occurrence of atherosclerosis and cardiovascular events, in the treatment of selected suitable scaffold, on coronary diabetic patients with ideal treatment effect. 1. Introduction Coronary heart disease is coronary artery occurred in Corresponding author: Chun-Xia He, First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Tel: 13932373776 E-mail:hcxwws@163.com atherosclerotic lesions caused by the vessel lumen stenosis or occlusion, leading to myocardial ischemia, hypoxia, or necrosis and lead to heart disease, it is the chronic complications of diabetes mellitus, is one of the main causes of death in diabetic patients. Diabetes is caused by multiple etiological factors, by chronic high blood glucose for the characteristics of a group of metabolic diseases, clinical features showed as follow fire namely
185 polydipsia, polyuria, polyphagia, weight loss, fatigue, weakness, etc[1,2]. Diabetes in itself does not necessarily cause serious harm, but long-term blood glucose will involve large blood vessels, microvascular damage, and endanger the heart, brain, kidney and peripheral neuropathy, etc.. According to the statistics, the complications of diabetes as high as more than and 100 kinds of. Brain derived neurotrophic factor (BDNF) is a novel angiogenic factor. Studies show BDNF can inhibit apoptosis of myocardial cell and promote ischemic endothelial cell proliferation and migration, induce neovascularization of ischemic tissue and is involved in the inflammatory response, and in atherosclerosis and ischemic cardiomyopathy expression changes; and BDNF in diabetes and its complications in the form of abnormal level of[3,4]. But the concentration of BDNF in the serum of patients with coronary heart disease complicated with diabetes has not been reported. In this study, by detecting the selected concentrations of BDNF in serum of patients with combined with the results of coronary artery angiography, Gensini score evaluation of serum BDNF levels and coronary artery stenosis by correlation and provide basis for the prevention and treatment of coronary heart disease complicated with diabetes mellitus. Blood lipid is the plasma or serum cholesterol, triglycerides, phospholipids and free fatty acids and other lipids, and hyperlipidemia is one of the abnormal blood lipid metabolism. Dyslipidemia is a major factor to cause the body of atherosclerosis, and the influence on glucose metabolism in the body, causing the metabolic syndrome, therefore in the treatment of dyslipidemia on blood lipid control has a very important role. This study analyzes the clinic diagnosis and treatment of diabetes mellitus complicated with coronary heart disease patients serum BDNF changes, blood tests and PCI, aimed at for clinical treatment of coronary heart disease with diabetes patients to provide some reference and ideas, report as follows now. 2. Data and methods 2.1. General information 59, 61, 64 cases of 64 cases of inclusion in 2013 March-2015 years 3 months in our hospital out-patient treatment in elderly patients with coronary heart disease complicated with diabetes mellitus patients with 126 cases of coronary heart disease combined with diabetes mellitus group, of which 62 male patients, female, aged 55 to 80 years old, average (65.64 ± 3.21) years old. At the same time were simple CHD patients with 125 cases were included in the coronary heart disease group, of which 61 male patients, female, aged 57 to 81 years old, average (67.23 ± 2.34) years old. In addition, during the same period of the physical health of 120 cases were included in the healthy control group, male and female, age ranged from 58 to 79 year old, average (64.36 ± 2.20) years old, excluding those with coronary heart disease, diabetes, simple disease. Coronary heart disease patients are in line with the diagnostic criteria of clinical ischemic heart disease, diabetes patients in line with the diagnostic criteria for clinical diabetes. All patients admitted to the hospital to improve the medical history collection, there is no blood disease, rheumatism, cancer, cerebrovascular disease, liver and gallbladder diseases, etc.. The subjects of this study are subject to the consent of the subjects and their families and sign the informed consent form. There was no significant difference in age, sex and other basic data (P > 0.05). 2.2. Exclusion and diagnostic criteria Coronary heart disease (CHD) with the 2007 edition of the China chronic stable angina guidelines on the diagnosis and treatment of diagnostic criteria[5] and coronary angiography results suggest that for any one coronary artery main branch in two different investment according to the position on the luminal diameter stenosis is more than or equal to 50%. Type 2 diabetes according to the diagnostic standard of diabetes in Chinese type 2 Diabetes Prevention Guide 2010 Edition[6], with diabetes related symptoms (due to hyperglycemia cause polyphagia, polydipsia, polyuria, weight loss, etc. the body metabolic disorders), and random blood glucose is more than or equal to 11.1 mmol/l; meal after 8 h of fasting blood glucose is more than or equal to 7.0 mmol/l or oral glucose tolerance Experiments 2 h blood glucose is more than or equal to 11.1 mmol/l; exclusion type I diabetes and other causes of elevated blood sugar disease. Exclusion criteria: (1) acute myocardial infarction or old myocardial infarction; (2) type I diabetes or a variety of acute and stress disorders associated with hyperglycemia disease and non endocrine disease caused by diabetes mellitus; (3) malignant tumor or chronic infection diseases; (4) serious liver and kidney function is not complete; (5) system sclerosis, system lupus lupus and rheumatoid arthritis autoimmunity diseases; (6) to take experimental results of drugs such as hormones, immunosuppressants may change. 2.3. Observation index and method All patients according to Gensini integration system and coronary artery vascular image segmentation evaluation criteria for each of the degree of vascular stenosis were evaluated. Gensini points for the degree of coronary artery stenosis, the degree of integration is multiplied by the location of the lesion and. Subjects were in fasted 12 h after fasting blood 3 ml, blood samples were placed in dry tubes, separation of serum within 1 h, make sure there is no hemolysis specimens, 2 h by automatic biochemical analyzer in serum were detected. Detection parameters mainly include total
186 cholesterol (TC), glycerin three fat (TG), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C), apolipoprotein A1 (APOA-1) and apolipoprotein B (APOB). At the same time to closely observe the patients in the treatment process of adverse reactions, and promptly make the appropriate treatment. The coronary angiography was performed by means of Judkins method in the femoral artery, and the drug stent was installed in the target lesion position according to the conventional method. Target lesion divided operation in the light of the development of the American College of Cardiology criteria, the understanding of captive pathological changes > 75% stenosis in patients of interventional therapy and in most of the lesions before stent implantation of balloon dilatation, for pathological changes has a long distance to two medals and over the stent placement, and overlap of 2-3 mm, and the position of the overlap of the implementation of the operation of high expansion. All patients with vascular lumen stenosis need greater than 4/5, with grade 3 and above TIMI blood flow, myocardial infarction and the occurrence of the phenomenon of; and no surgical emergency coronary artery bypass graft surgery for severe complications, and even death, said stents were successfully. The number of stents, mean diameter and length of stent in patients with coronary heart disease combined with diabetes mellitus and coronary heart disease group were compared. 2.4. Statistical treatment All data were analyzed using SPSS 20.0 statistical software and data processing, measurement data using (mean ± SD) said that the comparison between the two groups using t test, P<0.05 for the difference was statistically significant. 3. Results 3.1. Comparison of Gensini score and BDNF in each group Coronary heart disease combined with diabetes mellitus group Gensini score and serum BDNF concentration were higher than those of the coronary heart disease group and control group, the difference has statistics significance (P<0.05); coronary heart disease group Gensini score and serum BDNF concentration was higher than that of the control group compared with statistical significance (P <0.05). See table 1. Table 1. Comparison of Gensini score and BDNF in each group. Group n Gensini BDNF Diabetic with CHD 126 39.56±35.73 *# 1 204.45±138.76 *# CHD 125 19.86±18.26 * 1 015.87±84.65 * Control 120 5.96±3.98 913.15±57.46 Note: compared with the control group, * P<0.05, compared with the coronary heart disease group, # P<0.05. 3.2. Comparison of blood lipid levels in each group The levels of TC, TG, APO-B and LDL-C in the coronary heart disease group and CHD group were significantly higher than those in the control group, the levels of HDL-C and APOA-1 were significantly lower than those of the control group, the difference was statistically significant (P<0.05). The levels of TC, TG, APO-B and LDL-C were significantly higher in the patients with coronary heart disease combined with diabetes than those with CHD group, the difference was statistically significant (P<0.05). There was no significant difference in the level of HDL-C and APOA-1 between the two groups (P > 0.05). See table 2. 3.3. Comparison of the characteristics of PCI intervention in two groups In the two groups during the treatment, there were no adverse cardiovascular events. The success rate of stent placement in the two groups was 100%, and no complication occurred. The number and length of stent implantation in patients with coronary heart disease combined with diabetes mellitus were higher than that in CHD group, and the difference was statistically significant (P<0.05). The mean diameter of stent implantation in coronary heart disease patients with diabetes mellitus group was smaller than that in CHD group, and the difference was statistically significant (P<0.05). See table 3. Table 3. Groups undergoing PCI group interventional treatment characteristics do not compare. Group n Number of brackets Average diameter Stent length Diabetic with CHD 126 24.13±5.73 3.06±0.58 1.95±0.46 CHD 125 20.21±5.65 3.85±0.56 1.37±0.65 Note: compared with coronary heart disease group, # P<0.05. 4. Discussion Table 2. Comparison of blood lipid levels in each group (mmol/l). Group n TC TG LDL-C HDL-C APOA-1 APO-B Diabetic with CHD 126 9.34±1.55 *# 6.15±1.23 *# 6.93±3.21 *# 1.12±0.48 * 1.32±0.75 * 5.87±1.12 *# CHD 125 7.59±1.56 * 3.98±0.51 * 5.03±1.65 * 1.14±0.61 * 1.21±0.78 * 3.45±0.87 * Control 120 3.99±0.62 1.22±0.21 2.44±1.68 3.46±0.55 3.74±0.45 0.56±0.16 Note: compared with the control group, * P<0.05, compared with the coronary heart disease group, # P<0.05.
187 Coronary heart disease and the incidence of diabetes have a common pathological process, compared with patients with simple coronary heart disease, coronary heart disease and diabetes patients with more serious degree of coronary artery damage. Coronary angiography showed severe, multiple and erosive lesions, and the mortality was significantly higher than that of non diabetics. Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose. If the blood glucose level in diabetic patients is not effectively controlled, it will lead to chronic injury and dysfunction of the tissues and organs, especially the heart, kidney, eye, blood vessel and nerve. Due to the lack of insulin in the blood of patients with diabetes caused by fat metabolism disorders, and then cause the increase of blood lipids and platelet adhesion. Abnormal blood lipids in patients with diabetes, blood sugar, will further on vascular endothelial function damage, and easy to induce atherosclerosis and its in the pathological basis and coronary heart disease (CHD) there is similarity and abnormal glucose regulation will further induce atherosclerosis in patients with. The molecular mechanism may be related to high glucose induced protein oxidation and glycosylation, resulting in the formation of harmful substances in the formation of atherosclerosis, and further lead to the occurrence of coronary heart disease[7]. Coronary heart disease is one of the important factors that cause the death of patients with diabetes. The mortality rate of coronary heart disease is about half of the patients with coronary heart disease. Coronary heart disease and diabetes in patients with Gensini score was significantly higher than that in patients with coronary heart disease, which is consistent with current research results. In addition to playing an important role in the nervous system, there are more and more evidence that BDNF and cardiovascular health and atherosclerosis are closely related. The latest research shows that BDNF plays a protective role in the pathogenesis of cardiovascular disease, higher serum concentrations of BDNF lower cardiovascular morbidity and mortality of the disease. BDNF expression in type 2 diabetic patients in the marked decline in serum high concentrations of glucose output inhibit brain BDNF, while the low concentration of BDNF significantly increased the incidence of diabetes complications. Thus, BDNF involved in the pathogenesis and progression of coronary heart disease and diabetes. The results of this study show coronary heart disease combined with diabetes group Gensini score and serum BDNF concentrations were higher than the control group and CHD, CHD Gensini score and serum BDNF concentrations were higher (P<0.05); coronary heart disease may be due to merger atherosclerotic plaque lipid in diabetic patients are more endothelial damage is more serious, severe inflammation, accompanied by angiogenesis. The serum BDNF expression of smooth muscle while stimulating increased NADPH oxidase activity, affecting the stability of the plaque, on the other hand involved in the regulation of endothelial cells in a series of survival, proliferation, migration and other physiological activities, to a certain extent, affected the high inhibition of BDNF secretion of glucose concentration. Gensini serum BDNF concentration and a certain level of correlation, suggesting that serum BDNF expression levels may reflect a certain degree of coronary artery stenosis. At different levels on the basis of total cholesterol, diabetics are more likely associated with coronary heart disease. Total cholesterol levels in patients with coronary heart disease is an important indicator of lipids, atherosclerosis and its related to the development. The incidence of coronary heart disease was significantly higher in patients with diabetes, about 2 to 4 times that of other non-diabetic patients. Hypertriglyceridemia is a risk factor for coronary heart disease, diabetes occurs when elevated triglycerides, high density lipoprotein levels typically will decrease, and decreased highdensity lipoprotein levels will result in an increased incidence of coronary heart disease, we should closely monitor high-density lipoprotein levels in patients clinically. LDL is a kind of induced atherosclerosis lipoprotein, objectively reflect the degree of risk of coronary heart disease patients is its level of, when plasma LDL levels reach a certain degree of atherosclerotic plaque We will find the appropriate stop. APOA-1 as apolipoprotein component of HDL, better able to atherosclerosis indicative purposes, and be able to focus on the formation and development play inhibition. APO-B to apolipoprotein component of LDL, the occurrence of coronary heart disease is closely related to[8]. Coronary heart disease combined with diabetes and coronary heart disease group serum lipids in TC, TG, LDL-C, APO-B levels were significantly higher, HDL-C and APOA-1 levels were significantly lower than the control group, coronary heart disease combined with diabetes group lipids in TC, TG, LDL-C, APO-B levels were significantly higher in CHD group, the differences were statistically significant (P<0.05); described above: 1 as compared to healthy subjects, patients with coronary heart disease combined with diabetes. simple and coronary heart disease patients had varying degrees of lipid abnormalities. 2. The body insulin resistance in patients with diabetes or secretion, thereby reducing the ability to break down fat, and increased free fatty acids, which is leading a major factor in triacylglycerol higher level; 3 high-density lipoprotein levels in diabetic patients reduce, but also further weakened the ability of cholesterol uptake, so the patient's blood cholesterol levels tended to increase. Therefore, in patients with coronary heart disease and diabetes should actively glycemic control, lipid levels should also be closely monitored, will help reduce the incidence of cardiovascular disease. In addition, coronary heart disease in patients with diabetes typically have diffuse vascular disease, and the vessel diameter is smaller, the need to choose the right diameter and length of the stent to prevent the stent caused by excessive blood vessel wall perforation or Mezzanine. Diabetic patients with vascular disease, its metabolic disorders, more complications are closely related. Therefore, in clinical coronary artery disease patients with diabetes should pay attention to the implementation of intervention strategies carefully selected and reasonable. In this study, diabetic patients have a small diameter stents, stent length and large count more features, no
188 interventional treatment of complications. In this study, coronary heart disease and diabetes stent group were higher than the number and length of the CAD group (P<0.05); coronary heart disease combined with diabetes in vivo stenting group average diameter of less than CAD group (P<0.05). CHD group than a simple bracket to release the pressure slightly, mainly because of its heavy atherosclerosis, poor blood vessel elasticity, blood vessels expand too much, causing serious complications Vessel perforation or dissection. Internationally on coronary heart disease complicated by diabetes patients to choose the manner in which the reconstruction of coronary blood supply, still has considerable controversy[9]. In summary, coronary heart disease complicated diabetic patients with coronary artery stenosis in BDNF has a certain relevance, clinical lipid related indicators should be monitored regularly, and in combination with other laboratory examinations, blood lipid control, in order to reduce atherosclerosis and heart the occurrence of vascular events, and the choice of a suitable stent in the treatment of coronary heart disease patients with diabetes have the desired therapeutic effect, clinical research should continue to provide new ideas for treatment. References [1] Wang Yang interest, Qin Lijuan coronary heart disease risk factors for type 2 diabetes mellitus and coronary lesions characteristics. World Health Dig 2014; 17(12): 184-185. [2] Chamnan P, Simmons, Khaw KT. Change in Hb A1c over 3 years does not improve the prediction of cardiovascular disease over and above HbA1c measured at a single time point. Clin Exp Diabetes Metab 2013; 56(5): 625-629. [3] Liu Jinling atorvastatin and simvastatin in treating elderly patients with type 2 diabetes, coronary heart disease in comparison. Integr Cardiol 2015; 3(11): 3. [4] Gaggini M, Morelli M, Buzzigoli E. Non-alcoholic fatty liver disease (NAFLD) and its connection with insulin resistance, dyslipidemia, atherosclerosis and coronary heart disease. Nutrients 2013; 5(5): 1544-1560. [5] Chinese Medical Society of Cardiology, Journal of Cardiology Editorial Board. Chronic stable angina diagnosis and treatment guidelines. J Cardiol 2007; 35(3): 195-206. [6] Chinese Medical Association Diabetes Society, Chinese type 2 diabetes prevention guideline committee. China Type 2 Diabetes Prevention Guide (2010 edition). Chin J Diabetes 2012; 20(1): 81-117. [7] Neeland IJ, Patel RS, Eshtehardi P. Coronaryangiographic scoring systems: an evaluation of their equiva-lence and validity. Am Heart J 2012; 164(4): 547-552. [8] Chen Yuhong, Han Gang coronary heart disease and diabetes in patients with blood lipid testing results of the study. Int J Lab Med 2016; (1): 98-99. [9] Wu Yuntao, grace and high spring, and other heart disease patients with diabetes mellitus Biodegradable Polymer Sirolimus-eluting stent 5-year follow-up study implantation. Chin J Clin Healthcare 2015; 44(3): 468-470.