血清骨钙素水平与老年骨质疏松及冠状动脉病变的相关性

Relations between serum levels of osteocalcin and the diseases of osteoporosis and coronary artery calcifica-tion in elderly men

目的探讨血清骨钙素水平与老年骨质疏松及冠状动脉病变的相关性。方法选取183例年龄在60-85岁的患者，根据骨密度测定结果分为2组：非骨质疏松组86例，骨质疏松组97例；根据冠状动脉螺旋CT检查结果分为3组：轻度钙化组（积分〈200）68例；中度钙化组（200≤积分〈300）43例；重度钙化组（积分I〉300）72例。比较各组患者的冠状动脉狭窄病变和钙化程度。应用酶联免疫吸附试验者测定各组患者血清骨钙素水平。结果骨质疏松组患者合并肥胖、高血压、高血脂和糖尿病的比例分别为56．7％（55／97）、80．4％（78／97）、78．4％（76／97）、71．1％（69／97），高于非骨质疏松组的37．2％（32／86）、54．7％（47／86）、44．2％（38／86）、31．4％（27／86）（P〈0．05）；骨质疏松组患者血清骨钙素水平明显低于非骨质疏松组患者[（14．4±3）ng／L比（424±6）ng／L（P〈0．05）]；骨质疏松组患者任意冠状动脉分支的钙化程度均高于非骨质疏松组，2组比较差异有统计学意义（P〈0．05）。骨质疏松组冠状动脉单支病变超过50％狭窄者比例明显高于非骨质疏松组，冠状动脉2支以上病变者占比更高[20．6％（20／97）比3．5％（3／86）]，差异均有统计学意义（均P〈0．05）。冠状动脉血清骨钙素水平分别为（45．6±8．3）、（26．2±4．8）、（15．5±10．2）ng／L，任意两两比较差异均有统计学意义（均P〈0．01）。结论骨钙流失与钙质在冠状动脉的沉积存在共同的发病机制。该机制与血清骨钙素水平有关，血清骨钙素对老年男性骨质疏松与冠状动脉钙化有保护作用。

Objective To determine osteocalcin in serum in elderly man ; to discuss the effects of abnormal calcium metabolism between osteoporosis and coronary artery calcification in elderly men. Methods According to the results of the bone density, 183 patients with an age from 60 to 85 （72 ± 8.8 ）, were divided into two groups ： non-osteoporosis group （n = 86） and osteoporosis group （n = 97 ）. According to the results of coronary artery spiral CT, the patients mentioned above were divided into three groups： mild calcification group （calcification score 〈 200, n = 68）, middle calcification group （calcification score ≥ 200 and 〈 300, n = 43 ） and severe calcification group （calcification score ≥300, n = 72）. The stenosis of coronary artery and the degree of calcification were com- pared among the groups. Osteocalcin in serum was determined by using enzyme linked immunosorbent assay and its results were compared among the groups. Results The proportions of obesity, hypertension, hyperlipidemia and di- abetes were larger in osteoporosis group. Osteocalcin in serum of osteoporosis group was higher than that of non-oste- oporosis group. The degree of calcification in any branch of coronary artery of osteoporosis group was higher than that of non-osteoporosis group and there was a statistical significance between the two groups. The proportion of osteoporo- sis group was higher than that of non- osteoporosis group. The proportion of osteoporosis group was much higher than that of non- osteoporosis group. Osteocalcin in serum was decreased with the exacerbation of calcification of coronary artery and there was a statistical significance between osteocalcin and coronary artery calcification. Conclusions There is the same pathogenesis between the loss of calcium in bone and calcium deposition in coro- nary artery. This mechanism is related to osteocalcin in serum. Osteocalcin in serum avoids osteoporosis and coro- nary artery calcification.