冠心病患者血清脂联素、鸢尾素及肠道菌群水平与冠状动脉狭窄的关系分析

Relationship between Levels of Serum Adiponectin,Irisin and Intestinal Flora and Coronary Artery Stenosis in Patients with Coronary Heart Disease

目的 探究冠心病患者血清脂联素、鸢尾素及肠道菌群水平与冠状动脉狭窄的关系。方法 前瞻性选取2020年9月到2022年9月收治的冠心病患者103例作为观察组,根据冠状动脉病变支数及Gensini评分将其分为轻度狭窄组(54例,总评分≤24分)和中重度狭窄组(49例,总评分>24分);选取同期非冠状动脉狭窄的心血管疾病患者50例作为对照组。收集患者临床基线资料,采集患者外周静脉血及粪便标本,检测血清脂联素、鸢尾素及肠道菌群水平,分析上述指标与冠心病患者冠状动脉狭窄程度的关系。结果 中重度狭窄组患者糖尿病、吸烟史占比均高于对照组及轻度狭窄组,血清脂联素、鸢尾素水平均低于对照组及轻度狭窄组(P<0.05)。三组患者肠道菌群α多样性指数比较差异无统计学意义(P>0.05);中重度狭窄组患者拟杆菌门相对丰度低于对照组及轻度狭窄组,厚壁菌门相对丰度高于对照组及轻度狭窄组(P<0.05)。血清脂联素、鸢尾素与肠道拟杆菌门相对丰度呈正相关(r=0.327、0.254,P<0.05),与肠道厚壁菌门相对丰度呈负相关(r=-0.321、-0.247,P<0.05);血清脂联素、鸢尾素及肠道拟杆菌门相对丰度均与Gensini评分呈负相关(r=-0.328、-0.355、-0.309,P<0.05),肠道厚壁菌门相对丰度与Gensini评分呈正相关(r=0.320,P<0.05)。合并糖尿病、厚壁菌门是影响冠心病患者冠脉病变的危险因素,血清脂联素、鸢尾素、拟杆菌门均是冠心病患者冠脉病变保护因素(P<0.05)。结论 冠心病患者的血清脂联素、鸢尾素及肠道菌群与冠状动脉狭窄程度紧密相关,低水平血清脂联素、鸢尾素、肠道拟杆菌门相对丰度及高水平厚壁菌门相对丰度可能增加冠心病患者冠状动脉病变风险,值得临床重视。

Objective To explore the relationship between levels of serum adiponectin,irisin and intestinal flora and coronary artery stenosis in patients with coronary heart disease(CHD).Methods 103 patients with CHD admitted to the hospital from September 2020 to September 2022 were prospectively selected.According to the number of coronary artery lesions and Gensini score,CHD patients were divided into 54 patients in mild stenosis group(total score ≤ 24 points) and 49 patients in moderate to moderate-to-severe stenosis group(total score >24 points),and 50 patients with cardiovascular disease without coronary artery stenosis in the same period were selected as the control group.The clinical baseline data of patients were collected by questionnaire survey.Peripheral venous blood and stool samples were collected from the patients to detect the levels of serum adiponectin,irisin and intestinal flora,and relationship of the above indicators with degree of coronary artery stenosis in patients with CHD was analyzed.Results The proportions of patients with diabetes mellitus and smoking history in moderate-to-severe stenosis group were significantly higher than those in the control group and mild stenosis group,while serum levels of adiponectin and irisin were significantly lower than those in the control group and mild stenosis group (P<0.05).There were no statistical differences in α diversity indexes of intestinal flora between the three groups of patients (P<0.05).The relative abundance of Bacteroidetes in moderate-to-severe stenosis group was lower while the relative abundance of Firmicutes was higher compared to the control group and mild stenosis group (P<0.05).Serum adiponectin and irisin were positively correlated with relative abundance of intestinal Bacteroidetes (r=-0.327,-0.254,P<0.05),while the serum adiponectin and irisin were negatively correlated with relative abundance of intestinal Firmicutes (r=-0.321,-0.247,P<0.05).Serum adiponectin,irisin and relative abundance of intestinal Bacteroidetes were negatively correlated with Gensini score (r=-0.328,-0.355,-0.309,P<0.05),while the relative abundance of intestinal Firmicutes was positively correlated with Gensini score (r=0.320,P<0.05).Diabetes mellitus and Firmicutes were risk factors affecting coronary artery lesion in patients with CHD,and serum adiponectin,irisin and Bacteroidetes were protective factors for coronary artery lesion in patients with CHD (P<0.05).Conclusions Serum adiponectin,irisin and intestinal flora are closely related to the degree of coronary artery stenosis in patients with CHD.Low levels of serum adiponectin and irisin.low relative abundance of intestinal Bacteroidetes and high relative abundance of Firmicutes may increase the risk of coronary artery disease in patients with CHD,which is worthy of clinical attention.