术前血清OPG、sRANKL对经皮冠状动脉介入术患者危险分层与评估预后的价值

Risk Stratification and Prognostic Value of OPG and sRANKL in Serum in Patients Undergoing Percutaneous Coronary Intervention

目的 探讨术前血清骨保护素(OPG)、可溶性核因子κB受体活化因子配基(sRANKL)对经皮冠状动脉介入术(PCI)患者危险分层与评估预后的价值。方法 选取确诊为冠心病且行PCI患者223例,根据患者术前血清sRANKL/OPG比值将所有患者分为3组:A组、B组和C组。运用Gensini评分对患者血管狭窄程度进行判断。术后6个月内对患者进行随访,记录患者的主要心血管事件及分析患者血清OPG、sRANKL水平、sRANKL/OPG比值和血管病变支数、Gensini评分及主要不良心脏事件(MACE)和其他冠心病危险因素的关系。结果 3组患者在高血压病和血清OPG、sRANKL水平及sRANKL/OPG比值差异均有统计学意义(P<0.05);术前血清OPG、sRANKL水平及sRANKL/OPG比值与高敏肌钙蛋白T(hs-c Tn T)水平呈正相关(r=0.345、r=0.369、r=0.398,P=0.000、P=0.000、P=0.000),而血清OPG、sRANKL水平及sRANKL/OPG比值与高密度脂蛋白胆固醇(HDL-C)则呈负相关(r=-0.182、r=-0.165、r=-0.176,P=0.005、P=0.006、P=0.006);随着患者Gensini评分的升高,血清OPG、sRANKL水平及sRANKL/OPG比值亦升高(P<0.05),Gensini评分为重度血管狭窄和中度、轻度血管狭窄患者血清OPG、sRANKL水平、sRANKL/OPG比值差异均有统计学意义(P<0.05)。双变量Spearman相关分析表明,术前血清OPG、sRANKL水平、sRANKL/OPG比值与Gensini评分的相关系数分别为0.22(P<0.05)、0.20(P<0.05)、0.17(P<0.05)。术后6个月内3组患者MACE发生率比较差异有统计学意义(P<0.05),且3组患者靶病变血运重建率的比较差异有统计学意义(P<0.05)。术前血清OPG、sRANKL水平、sRANKL/OPG比值是患者发生MACE的独立危险因素(OR=2.17、2.23、2.26,95%CI:1.33~3.46、1.45~3.77、1.55~3.89,P=0.006、0.005、0.003)。结论 术前血清OPG、sRANKL水平及sRANKL/OPG比值与高血压、肌钙蛋白、冠脉病变呈正相关,与HDL-C呈负相关,为PCI术后心脏不良事件的独立危险因素,为PCI术后患者的危险分层和预后评估增添临床指标。

Objective To investigate the value of osteoprotegerin（OPG） and receptor activator of nuclear factor-kappa B ligand（sRANKL） in serum in risk stratification and prognosis in patients undergoing percutaneous coronary intervention（PCI）. Methods A total of 223 patients diagnosed as coronary heart disease and scheduled to undergoing PCI were enrolled,and according to the ratio of sRANKL to OPG in serum,all patients were divided into three groups： A,B and C group. The degree of coronary artery stenosis was evaluated by using Gensini＇s score. Within six months after surgery the patients were followed up,major cardiovascular events were recorded,and the levels of OPG and sRANKL in serum,the ratio of sRANKL to OPG,the number of diseased vessels,Gensini＇s score,major adverse cardiac events（MACE） and other coronary heart disease risk factors were analyzed. Results Hypertension and the levels of OPG and sRANKL in serum or the ratio of sRANKL to OPG existed significant differences（P〈0.05） in three groups of patients. Preoperative high sensitivity cardiac troponin T（c Tn T） and the levels of OPG and sRANKL in serum or the ratio of sRANKL to OPG showed positive correlation（r = 0.345,r = 0.369,r = 0.398; P = 0.000,P = 0.000,P = 0.000）,and there was negative correlation（r =-0.182,r =-0.165,r =-0.176; P = 0.005,P = 0.006,P = 0.006） between the levels of OPG and sRANKL in serum or the ratio of sRANKL to OPG and high-density lipoproteincholesterol（HDL-C）. With Gensini score increased,the levels of OPG and sRANKL in serum or the ratio of sRANKL to OPG were increased（P〈0.05）,and there was statistical significance（P〈0.05） in the levels of OPG and sRANKL in serum or the ratio of sRANKL to OPG of patients with severe,moderate and mild vascular stenosis. Bivariate Spearman correlation analysis showed that,the correlation coefficients between the preoperative levels of OPG and sRANKL in serum or the ratio of sRANKL to OPG and Gensini score were 0.22（P〈0.05）,0.20（P〈0.05） and 0.17（P〈0.05）,respectively. Within six months after the operation,the incidence of MACE in three groups of patients showed statistical significance（P〈0.05）,and target lesion blood supply reconstruction rate difference was statistically significant（P〈0.05）. The preoperative levels of OPG and sRANKL in serum or the ratio of sRANKL to OPG were an independent risk factor in patients with MACE（OR = 2.17,2.23,2.26; 95% CI： 1.33-3.46,1.45-3.77,1.55-3.89; P = 0.006,0.005,0.003）. Conclusion The preoperative levels of OPG and sRANKL in serum or the ratio of sRANKL to OPG are related to vascular lesions of patients undergoing PCI and an independent risk factor in patients with MACE,and thus providing risk stratification and prognosis and better clinical reference value for cardiovascular events after PCI in patients with coronary heart disease.