血清骨保护素和脑利钠肽水平与非ST段抬高型急性冠状动脉综合征患者冠状动脉病变程度的相关性

The Relationship Between Osteoprotegerin and Brain Natriuretic Peptide Levels and Degree of Coronary Disease in Patients with non-ST Elevation Acute Coronary Syndrome

目的探讨血清骨保护素和脑利钠肽水平与非ST段抬高急性冠状动脉综合征患者冠状动脉病变程度之间的关系。方法 192例受试者分为三组:稳定型心绞痛患者58例,不稳定型心绞痛/非ST段抬高心肌梗死患者99例,对照者35例,入院时检测血清骨保护素和脑利钠肽水平,并进行冠状动脉造影。根据造影结果对冠状动脉病变进行Gensini评分,分析两种标志物与冠状动脉狭窄数及冠状动脉病变Gensini评分的相关性。结果所有冠心病患者骨保护素水平高于对照组(P<0.01),稳定型心绞痛组骨保护素水平低于不稳定型心绞痛/非ST段抬高心肌梗死组(P<0.01);稳定型心绞痛组脑利钠肽水平略高于对照组(P>0.05),不稳定型心绞痛/非ST段抬高心肌梗死组脑利钠肽水平明显高于稳定型心绞痛组(P<0.01);多支血管病变患者脑利钠肽水平显著高于单支血管病变患者(P<0.01),脑利钠肽与冠状动脉病变Gensini评分轻微相关(r=0.45,P<0.01),骨保护素与冠状动脉病变Gensini评分显著相关(r=0.64,P<0.001),多元回归分析发现骨保护素和脑利钠肽与冠心病独立相关(P<0.01)。结论血清骨保护素与不稳定型心绞痛/非ST段抬高心肌梗死患者冠状动脉狭窄程度及病变进展有关,提示骨保护素可能参与了冠状动脉疾病的进程。不稳定型心绞痛/非ST段抬高心肌梗死患者脑利钠肽水平也增高,表明脑利钠肽水平与缺血范围以及严重程度有较大的关联。

Aim To analyse osteoprotegerin（OPG） and brain natriuretic peptide（BNP） levels in patients with non-ST elevation acute coronary syndrome（NSTE-ACS）,in relation to clinical presentation and to coronary coronary artery disease. Methods 192 consecutive patients were classified into three groups： stable angina（SA） group,unstable angina/non-ST elevation myocardial infarction（NSTE-ACS） group and control group,OPG and BNP levels were measured.OPG and BNP were compared in relation to the number of coronary artery disease,and to the stenoses degree by Gensini score. Results OPG levels were higher in all coronary artery disease patients compared to controls（P〈0.01）,however NSTE-ACS patients had higher OPG level with respect to SA patients（P〈0.01）.BNP levels were higher in NSTE-ACS patients compared to controls and SA patients（P〈0.01）.BNP levels was significantly higher in multivessels compared with 1-vessel disease（P〈0.01）.A positive relation was found between OPG levels and Gensini score（r=0.64,P〈0.001）.Only a mild correlation was found between BNP and Gensini score（r=0.45,P〈0.01）.Multiple regression analysis showed that OPG and BNP levels were independently and positively associated with the presence of coronary disease（P〈0.01）. Conclusions NSTE-ACS patients show high OPG levels.OPG is related to the number of coronary artery disease,which suggest its involvement in the coronary artery disease progression.BNP is also increased during NSTE-ACS and more associated to the scope and severity of ischemia.