血清C1q/肿瘤坏死因子相关蛋白3、C1q/肿瘤坏死因子相关蛋白9水平与冠状动脉钙化及严重程度的关系

The relationships between serum CTRP3,CTRP9 levels and coronary artery calcification and severity in non-diabetic patients

目的检测C1q/肿瘤坏死因子相关蛋白3(CTRP3)、C1q/肿瘤坏死因子相关蛋白9(CTRP9)在冠状动脉钙化(CAC)病人血清中的表达情况,探讨两者与CAC严重程度的关系。方法选取2017年8月至2019年7月邯郸市中心医院接收的CAC病人128例,按照冠状动脉钙化积分(CACS)将其分为少量钙化组(28例)、轻度钙化组(32例)、中度钙化组(38例)和重度钙化组(30例),选取同期健康者130例为健康对照组。分别采集两组外周血并分离出血清,利用酶联免疫吸附法(ELISA)检测血清中CTRP3、CTRP9的表达水平,使用全自动生化分析仪分析血脂指标三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)以及低密度脂蛋白胆固醇(LDL-C)水平,采用Pearson法分析CAC病人血清中CTRP3、CTRP9水平与TG、TC、HDL-C、LDL-C的相关性,采用多因素logistic回归分析影响CAC发生的因素。结果与健康对照组相比,CAC组血清中CTRP3[(67.26±7.58)μg/L比(80.05±16.23)μg/L]、CTRP9[(34.15±2.65)μg/L比(39.26±3.12)μg/L]和HDL-C水平[(1.17±0.22)mmol/L比(1.64±0.31)mmol/L]明显下降(P<0.05),TC[(5.43±0.86)mmol/L比(4.52±0.53)mmol/L]、TG[(1.99±0.41)mmol/L比(1.58±0.27)mmol/L]、LDL-C水平[(3.57±0.34)mmol/L比(3.06±0.19)mmol/L]、收缩压[(134.78±12.63)mmHg比(121.74±11.85)mmHg]、舒张压[(85.42±7.84)mmHg比(70.67±6.01)mmHg]明显升高(P<0.05);随着少量钙化的发生及CAC病人CACS的升高,CTRP3、CTRP9和HDL-C水平明显下降(P<0.05),TC、TG、LDL-C水平明显升高(P<0.05);年龄、收缩压、舒张压在四组不同钙化组中总体呈上升趋势(P<0.05);CAC病人血清中CTRP3、CTRP9水平与TC、TG水平均明显负相关(P<0.05),与HDL-C水平均明显正相关(P<0.05);CTRP3、CTRP9、HDL-C是影响CAC发生的保护因素,TC、TG、LDL-C水平均是影响CAC发生的危险因素。结论CAC组病人血清中CTRP3、CTRP9表达均明显下调,其表达水平均随着CAC组病人冠状动脉钙化程度的加重而下调,且与部分血脂指标关系密切,是影响CAC发生的保护因素,可作为CAC早期诊断的指标及CAC严重程度的标志物。

Objective To detect the expressions of C1q/tumor necrosis factor-related protein 3(CTRP3)and C1q/tumor necrosis factor-related protein 9(CTRP9)in serum of non-diabetic patients with coronary artery calcification(CAC),and to explore their relationships with incidence and severity of CAC.Methods A total of 128 non-diabetic patients with CAC admitted to Handan Central Hospital from August 2017 to July 2019 were selected and divided into small amount of calcification group(28 cases),mild calcification group(32 cases),moderate calcification group(38 cases)and severe calcification group(30 cases)according to the coronary artery calcification score(CACS),and 130 healthy people in the same period were selected as control group.Peripheral blood samples were collected from non-diabetic CAC patients and healthy people,and hemorrhagic serum was separated,the expression levels of CTRP3 and CTRP9 in serum were detected by enzyme-linked immunosorbent assay(ELISA),the levels of triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C)were analyzed by automatic biochemical analyzer,and Pearson method was used to analyze the correlations between serum CTRP3 and CTRP9 levels and TG,TC,HDL-C,LDL-C in non-diabetic patients with CAC,multivariate logistic regression was used to analyze the factors affecting the occurrence of CAC.Results Compared with the control group,the levels of serum CTRP3[(67.26±7.58)μg/L vs.(80.05±16.23)μg/L],CTRP9[(34.15±2.65)μg/L vs.(39.26±3.12)μg/L]and HDL-C[(1.17±0.22)mmol/L vs.(1.64±0.31)mmol/L]in CAC group decreased significantly(P<0.05),while the levels of TC[(5.43±0.86)mmol/L vs.(4.52±0.53)mmol/L],TG[(1.99±0.41)mmol/L vs.(1.58±0.27)mmol/L],LDL-C[(3.57±0.34)mmol/L vs.(3.06±0.19)mmol/L],systolic blood pressure[(134.78±12.63)mmHg vs.(121.74±11.85)mmHg]and diastolic blood pressure[(85.42±7.84)mmHg vs.(70.67±6.01)mmHg]increased significantly(P<0.05).With the occurrence of low CACS and the increase of CACS in non-diabetic CAC patients,the levels of CTRP3,CTRP9 and HDL-C decreased significantly(P<0.05),while the levels of TC,TG,LDL-C,age,systolic blood pressure and diastolic blood pressure increased significantly(P<0.05).The levels of serum CTRP3 and CTRP9 in non-diabetic CAC patients were negatively correlated with TC and TG levels(P<0.05),and positively correlated with HDL-C level(P<0.05).CTRP3,CTRP9 and HDL-C were protective factors affecting the occurrence of CAC,while TC,TG and LDL-C levels were risk factors affecting the occurrence of CAC.Conclusions The expressions of CTRP3 and CTRP9 in serum of non-diabetic patients with CAC are significantly down-regulated.The expression levels are down-regulated with the increase of coronary artery calcification in non-diabetic patients with CAC,and are closely related to some blood lipid index.They are protective factors affecting the occurrence of CAC and can be used as indicators of early diagnosis of CAC and markers of the severity of CAC.