急性冠脉综合征患者经皮冠状动脉介入治疗前后血清骨保护素浓度的变化

Chang of serum concentrations of osteoprotegerin in patients with acute coronary syndrome before and after percutaneous coronary intervention

目的探讨血清骨保护素(osteoprotegerin,OPG)对急性冠脉综合征(acute coronary syndrome,ACS)的预测价值及对经皮冠状动脉介入(percutaneous coronary intervention,PCI)的预后判断,并评价在进行血运重建时可能造成的心肌损伤。方法把60例冠状动脉粥样硬化性心脏病(冠心病)患者分为ACS PCI治疗组(n=30)和稳定型心绞痛(stable angina pectoris,SAP)PCI组(n=30)。并设30例冠状动脉造影正常的患者为正常对照组。采用酶联免疫吸附试验(ELISA)法测定3组患者术前、术后1 h和12 h时的血清OPG浓度。对成功接受PCI治疗的患者临床随访6个月,观察主要心血管事件(major adverse cardiac events,MACE)在各组患者中的发生情况。结果术前ACS PCI治疗组的血清OPG浓度较SAP PCI治疗组及对照组高,SAP PCI治疗组较对照组高,差异有统计学意义[(150.65±32.33)pg/mL vs.(127.63±20.23)pg/mL vs.(101.25±9.45)pg/mL,P<0.01]。ACS PCI治疗组及SAP PCI治疗组术后1 h血清OPG浓度与各自术前比较,差异无统计学意义(P>0.05);但术后12 h较术前均有显著升高,差异有统计学意义(P<0.05)。ACS PCI治疗组及SAP PCI治疗组的球囊扩张总时间(r=0.458,P=0.001)、总压力(r=0.467,P=0.001)、次数(r=0.398,P=0.007)与术后12 h血清OPG浓度呈正相关。随访期间有6例患者发生MACE,均是血清OPG浓度>150.24 pg/mL的患者。结论 OPG可能是ACS有价值的预测因子,也是患者PCI治疗后发生MACE的危险因子。PCI治疗后血清OPG浓度升高可能反映术中患者出现心肌损伤。

Obejectives To investigate the value of osteoprotegerin （OPG） in predicting acute coronary syndrome （ACS） and to estimate the likely myocardium injury during percutaneous coronary intervention （PCI） for revascularize. Methods A total of 60 patients with coronary heart disease were divided into ACS PC/group（n=30） and stable angina pectoris （SAP） PCI group （n=30）, and another 30 patients with normal coronary arteriograms were in control group. Serum concentrations of OPG were determined by enzyme-linked immunosorbent assay （ELISA） before, 1 h and 12 h after PCI. The occurrences of major adverse cardiac events （MACE） in all the groups were observed during a 6-month follow-up. Results Serum concentration of OPG was significantly higher in ACS PCI group than those in SAP PCI group and control group before PCI, and it was significantly higher in SAP PCI group than that in control group [ （ 150.65 ±32.33 ） pg/mL vs. （127.63±20.23） pg/mL vs. （101.25±9.45） pg/mL, P〈0.01 ]. There was no apparent difference in serum concentration of OPG before and 1 h after PCI in ACS group and SAP group, but it ascended in 12 h and was statistically significant （P〈0.05）. Concentration of OPG was positively correlated with the total time, pressure and times of balloon-expansion in PCI （r=0.458, P=0.001 ; r=0.467, P=0.001 ; r=0.398, P=0.007）. During the 6-month follow-up, 6 patients with serum concentration of OPG 〉 150.24 pg/mL suffered from MACE. Conclusions OPG may be a valuable predictor for ACS and risk factor for MACE after PCI. The raised concentration of OPG may indicate myocardium injury during PCI.