2型糖尿病并冠心病患者血清护骨素水平的变化及意义

The change and significance of serum osteoprotegerin level in patients with type 2 diabetes mellitus complicated with coronary heart disease

目的 研究2型糖尿病并冠心病患者血清护骨素（OPG）水平的变化以及血清OPG水平与冠心病严重程度之间的关系.方法 选择2型糖尿病并冠心病患者108例（糖尿病并冠心病组）,其中急性冠状动脉综合征68例,稳定型心绞痛40例.选择年龄、性别相匹配的无血管并发症的2型糖尿病患者60例（糖尿病非冠心病组）及40例健康体检者（对照组）.应用酶联免疫吸附试验法测定各组血清OPG水平.结果 糖尿病并冠心病组血清OPG水平（4.12±0.71） ng/L,显著高于糖尿病非冠心病组的（2.69±0.52） ng/L和对照组的（2.14±0.37） ng/L,差异有统计学意义（P＜ 0.05或＜ 0.01）.糖尿病并冠心病组中,急性冠状动脉综合征患者血清OPG水平（4.56±0.92） ng/L,显著高于稳定型心绞痛患者的（3.61±0.76） ng/L,差异有统计学意义（P＜0.05）.Gensini积分＞40分患者（41例）血清OPG水平为（4.92±0.89） ng/L,显著高于Gensini积分20～40分患者（53例）的（4.08±0.75） ng/L和Gensini积分＜20分患者（14例）的（3.39±0.85） ng/L,差异有统计学意义（P＜ 0.01或＜0.05）,而且Gensini积分20～40分患者血清OPG水平高于Gensini积分＜20分患者,差异有统计学意义（P＜ 0.05）.单支病变（16例）、双支病变（57例）及三支病变（35例）患者血清OPG水平[（3.52±0.82）、（4.54±0.68）、（4.75±0.93） ng/L]与对照组比较差异有统计学意义（P＜0.05）;双支病变、三支病变患者血清OPG水平显著高于单支病变患者,差异有统计学意义（P＜0.05）;三支病变患者与双支病变患者血清OPG水平比较差异无统计学意义（P＞0.05）.Logistic回归分析结果显示糖化血红蛋白、总胆固醇、超敏C反应蛋白和OPG是2型糖尿病并冠心病的独立危险因素.结论 2型糖尿病并冠心病患者血清OPG水平显著高于无血管并发症者,而且血清OPG水平与冠心病的严重程度有关,血清OPG水平是2型糖尿病并冠心病的独立影响因素.

Objective To investigate the change of serum osteoprotegerin level and relationships between serum osteoprotegerin level and coronary heart disease （CHD） in patients with type2 diabetes mellitus （DM） complicated with CHD.Methods One hundred and eight patients with type 2 DM complicated with CHD were selected as DM with CHD group,including 68 cases with acute coronary syndrome and 40 cases with stable angina pectoris.In addition,60 type 2 DM patients without CHD （DM without CHD group） and 40 healthy people （control group） were selected.Serum osteoprotegerin level was measured by enzyme linked immunosorbent assay.Results The serum osteoprotegerin level in DM with CHD group was significantly higher than that in DM without CHD group and control group [（4.12 ± 0.71）ng/L vs.（2.69 ± 0.52） and （2.14 ± 0.37） ng/L],and there were statistical differences （P＜ 0.05 or ＜ 0.01）.In DM with CHD group,the serum osteoprotegerin level in acute coronary syndrome was significantly higher than that in stable angina pectoris [（4.56 ±0.92） ng/L vs.（3.61 ±0.76） ng/L],and there was statistical difference （P ＜ 0.05）.The serum osteoprotegerin level in patients with Gensini score ＞ 40 scores （41 cases）was significantly higher than that in patients with Gensini score 20-40 scores （53 cases） and patients with Gensini score ＜ 20 scores （14 cases） [（4.92 ± 0.89） ng/L vs.（4.08 ± 0.75） and （3.39 ± 0.85） ng/L],and there were statistical differences （P ＜ 0.01 or ＜ 0.05）.The serum osteoprotegerin level in patients with Gensini score 20-40 scores was significantly higher than that in patients with Gensini score ＜ 20 scores,and there was statistical difference （P ＜0.05）.The serum osteoprotegerin level in single-vessel lesion （16 cases）,double-vessel lesion （57 cases） and three-vessel lesion （35 cases） [（3.52 ± 0.82）,（4.54 ± 0.68）,（4.75 ±0.93） ng/L] were significantly higher than those in control group,and there were statistical differences （P ＜ 0.05）; and the serum osteoprotegerin level in double-vessel lesion and three-vessel lesion were significantly higher than those in single-vessel lesion,and there were statistical differences （P ＜ 0.05） ;there was no statistical difference between three-vessel lesion and double-vessel lesion（P＞ 0.05）.The results of Logistic regression analysis showed that glycosylated hemoglobin,total cholesterol,high sensitivity C reactive protein and osteoprotegerin were independent risk factors of type 2 DM complicated with CHD.Conclusions Serum osteoprotegerin level in patients with type 2 DM complicated with CHD is significantly increased.There is a significant association between serum osteoprotegerin level and the presence and severity of CHD,and the serum osteoprotegerin level is independent risk factors of type 2 DM complicated with CHD.