血浆骨保护素评价老年人冠心病临界病变预后的意义

Intermediate coronary lesions：prognostic evaluation of plasma osteoprotegerin in elderly patients

目的探讨老年人血浆骨保护素评价冠心病临界病变预后的意义。方法回顾性分析，人选标准的冠心病或可疑胸痛的患者，在3支主要血管中选择狭窄20％～70％的临界病变，作为靶血管进行定量冠状动脉造影（QCA）分析。应用蛋白芯片法检测血浆中的骨保护素水平，采用酶联免疫吸附法检测高敏C反应蛋白（hs—CRP）浓度。随访有无临床终点事件发生。结果890例患者人选该研究，分为非老年组（370例）和老年组（520例）。两组年龄、吸烟、高血压史、三酰甘油（TG）、高密度脂蛋白胆固醇酯（HDL—C）、白细胞计数、骨保护素、收缩压、舒张压、体质指数（BMI）比较，差异有统计学意义，QCA分析的冠状动脉病变的形态学指标两组差异亦无统计学意义。随访中位数时间24个月，老年组58例（11．2％）患者发生临床终点事件。对老年组患者以年龄、吸烟、高血压、总胆固醇、TG、HDL—C、白细胞计数、骨保护素二分位、高hc—CRP、收缩压、舒张压、体质指数为白变量，以临床终点事件为因变量，进行前向多元Logistic回归分析，结果显示HDL-C、骨保护素二分位、hs—CRP均为独立危险因素。骨保护素二分位中，高分位患者发生心血管事件的风险是低分位组的2．510倍。结论高水平的骨保护素和hs—CRP是老年人冠心病临界病变发病的独立危险因素。

Objective To investigate the evaluation of plasma osteoprotegerin （OPG） measurement for assessing the prognosis of intermediate coronary lesions in elderly patients. Methods We retrospectively analyzed patients met the inclusion criteria of suspicious chest pain or confirmed coronary artery disease （CHD）, and intermediate stenosis lesions （20 %- 70% ） in 3 main coronary arteries served as target vessels for qualitative comparative analysis（QCA）. Plasma OPG level was detected by protein array method, and the concentration of hypersensitive C-reactive protein （hs-CRP）was determined by enzyme-linked immunosorbent assay（ELISA）. Clinical endpoints were followed up. Results A total of 890 patients with intermediate coronary stenosis were enrolled in this study, and were divided into〈60 years of age group（n=370）and ≥60 years of age group（n= 520）. There were statistical differences in age, smoking history, hypertension history, triglycerides （TG）, high-density lipoprotein cholesterol（HDL-C）, white blood cell count, OPG, systolic blood pressure（SBP） , diastolic blood pressure（DBP）, body mass index（BMI）between the two groups. The morphological indices in coronary lesions assessed by QCA had no differences between the two groups. During a median of 24 months of follow-up, 58 patients（11.2%）had clinical endpoints events. Age, smoking history, hypertension history, TC, TG, HDL-C, white blood cell count, levels of OPG above-median, hs-CRP, SBP, DBP, and BMI were used as the independent variables, and the clinical end events as the dependent variable. Forward stepwise logistic regression analysis showed that HDL- C, levels of OPG above-median, hs-CRP were the independent risk factors in elderly patients. The risk of cardiovascular events in patients with levels of OPG above-median was 2. 510 fold higher than those with levels of OPG below-median. Conclusions The high levels of OPG and hs-CRP are the independent risk factors for the occurrence of coronary heart disease in the elderly with intermediate coronary lesions.