Akboğa Mehmet Kadri, Taçoy Gülten, Yılmaz Demirtaş Canan, Türkoğlu Sedat, Boyacı Bülent, Çengel Atiye
Department of Cardiology, Gazi University Faculty of Medicine, Ankara, Turkey.
Turk Kardiyol Dern Ars. 2017 Jun;45(4):316-323. doi: 10.5543/tkda.2017.96169.
Ghrelin exerts protective effects on cardiovascular system by inhibiting progression of atherosclerosis, supression of vascular inflammation, and stimulating angiogenesis. Thus, the aim of this study was to investigate the effect of serum ghrelin on coronary collateral development and SYNTAX score in patients with severe coronary artery disease.
Total of 91 patients who had ≥90% stenosis in at least one major coronary artery were prospectively included in this cross-sectional, observational study. Collateral degree was graded according to Rentrop-Cohen classification. Patients with grade 2 or 3 collateral degree were allocated to Good Collateral Group and patients with grade 0 or 1 collateral degree were included in Poor Collateral Group. Ghrelin and vascular endothelial growth factor A (VEGF-A) levels were measured using radioimmunoassay and ELISA kits.
Serum ghrelin and VEGF-A levels were significantly higher in Good Collateral Group. Furthermore, ghrelin level showed significant inverse correlation with SYNTAX score (r=0.348; p=0.001). In multivariable regression analysis, ghrelin (Odds ratio, 1.013; 95% confidence interval, 1.011-1.017; p=0.013), VEGF-A, fasting plasma glucose and presence of chronic total occlusion were independent predictors of good collateral development. In receiver operating characteristic curve analysis, ghrelin value cut-off point of ≥781 pg/mL predicted good collateral development with sensitivity of 73.1% and specificity of 67.7%.
Findings suggested that ghrelin has antioxidant and antiinflammatory properties that protect endothelial functions and also stimulate angiogenesis, which results in development of good coronary collateral and inhibition of progression of coronary atherosclerosis.
胃饥饿素通过抑制动脉粥样硬化进展、抑制血管炎症和刺激血管生成对心血管系统发挥保护作用。因此，本研究旨在探讨血清胃饥饿素对严重冠状动脉疾病患者冠状动脉侧支循环发育及SYNTAX评分的影响。
本横断面观察性研究前瞻性纳入了91例至少一条主要冠状动脉狭窄≥90%的患者。根据Rentrop-Cohen分类法对侧支循环程度进行分级。侧支循环程度为2级或3级的患者被分配到良好侧支循环组，侧支循环程度为0级或1级的患者被纳入不良侧支循环组。使用放射免疫分析法和酶联免疫吸附测定试剂盒测量胃饥饿素和血管内皮生长因子A（VEGF-A）水平。
良好侧支循环组的血清胃饥饿素和VEGF-A水平显著更高。此外，胃饥饿素水平与SYNTAX评分呈显著负相关（r=0.348；p=0.001）。在多变量回归分析中，胃饥饿素（比值比，1.013；95%置信区间，1.011-1.017；p=0.013）、VEGF-A、空腹血糖和慢性完全闭塞的存在是良好侧支循环发育的独立预测因素。在受试者工作特征曲线分析中，胃饥饿素值截断点≥781 pg/mL预测良好侧支循环发育的敏感性为73.1%，特异性为67.7%。
研究结果表明，胃饥饿素具有抗氧化和抗炎特性，可保护内皮功能并刺激血管生成，从而导致良好冠状动脉侧支循环的发育并抑制冠状动脉粥样硬化的进展。
