老年人血清骨硬化蛋白与冠心病及骨质疏松的相关性研究

The relationship among serum sclerostin, coronary atherosclerotic heart disease, and osteoporosis in the elderly

目的探讨老年人血清骨硬化蛋白水平与冠心病及骨质疏松的相关性。方法入选重庆医科大学附属第二医院老年心血管科2014年10月至2015年10月因胸痛待查入院行冠状动脉造影的老年患者313例,其中诊断为冠心病的患者163例,非冠心病患者150例,取术前空腹静脉血用ELISA法测定血清骨硬化蛋白水平,同时测定骨密度及血脂、骨转换标志物等生化指标。采用多因素logistic回归模型分析骨硬化蛋白水平与冠心病发生的相关性,用多元线性回归分析影响骨硬化蛋白水平的相关因素。结果 (1)老年冠心病组骨硬化蛋白水平显著低于非冠心病组[(178.035±0.636)pg/m Lvs(180.576±0.608)pg/m L,P<0.05];(2)多因素logistic回归提示老年患者骨硬化蛋白与冠心病发生负相关(OR=0.865,P=0.018),其中骨质疏松患者骨硬化蛋白水平升高可降低罹患冠心病的风险(OR=0.767,P=0.007),非骨质疏松患者骨硬化蛋白与冠心病无相关性(P>0.05);(3)多元线性回归提示骨硬化蛋白水平与腰椎骨密度(β=0.224,P<0.05)、I型胶原氨基端延长肽(β=0.161,P<0.05)、年龄(β=-0.162,P<0.05)显著相关。结论血清骨硬化蛋白与老年患者尤其是合并骨质疏松的老年患者冠心病发生密切相关,并可能在骨-血管轴中发挥信使作用。

Objective To assess the relationship among serum sclerostin,coronary atherosclerotic heart disease（CHD）,and osteoporosis. Methods Three hundred and thirteen elder patients who underwent coronary angiography（CA） were involved in the cross-sectional study,including 163 subjects in CHD group and 150 subjects in non-CHD group. Serum sclerostin concentration was measured using a commercially available enzyme-linked immunosorbent assay kit. Bone mineral density（BMD）,serum lipid,and bone turnover markers were also detected. The correlation between sclerostin and CHD was analyzed using multiple logistic regression method. The influential factors of sclerostin were also analyzed. Results（1） Serum sclerostin concentration were lower in elder patients in CHD group than that in non-CHD group（178. 035 ± 0. 636 pg/mL vs. 180. 576 ± 0. 608 pg/mL,P〈0. 05）.（2） Multiple logistic regression analysis showed that sclerostin as negatively correlated with the occurrence of CHD in the elderly（OR = 0. 865,P = 0. 018）. Elevation of sclerostin was associated with low risk of CHD in osteoporotic patients（OR =0. 767,P = 0. 007）. Sclerostin was not associated with CHD in non-CHD group（P〉0. 05）.（3） In the multiple regression analysis,sclerostin was significantly associated with BMD（β = 0. 224,P〈0. 05）,PINP（β = 0. 161,P〈0. 05）,and age（β =-0. 162,P〈0. 05）. Conclusion Serum sclerostin is closely associated with CHD in the elderly,especially in the elder patients with osteoporosis. It may play a major modulator role in the bone-vessel-axis.