慢性心力衰竭患者血清OPG、sRANKL与骨质疏松相关分析

Correlation analysis between serum OPG,sRANKL and osteoporosis in patients with chronic heart failure

目的观察慢性心力衰竭(chronic heart failure,CHF)患者中血清骨保护素(osteoprotegerin,OPG)、可溶性核因子-κB受体活化因子配体(soluble receptor activator of nuclear factor-κB Ligand,sRANKL)的表达水平,探究二者与骨质疏松症(osteoporosis,OP)的关系,为诊断和干预CHF患者OP提供价值。方法选取2020年1月至2021年8月在承德医学院附属医院住院的CHF患者,检测其血清OPG、sRANKL、骨密度水平,通过骨量分为非骨质疏松组、骨质疏松组。比较两组血清OPG、sRANKL水平及其与骨密度相关性,分析其对CHF患者OP的诊断价值。结果①CHF患者骨质疏松组血清OPG、sRANKL水平均较非骨质疏松组高,差异具有统计学意义(P<0.001);②CHF患者中血清OPG、sRANKL水平与骨密度均呈负相关(r=-0.595、-0.458,P<0.001);③血清OPG、sRANKL是CHF患者OP的危险因素(OR=1.004,P=0.005;OR=1.061,P=0.011);④采用ROC曲线分析CHF患者中血清OPG、sRANKL水平对诊断OP的价值,曲线下面积(AUC)分别为0.761、0.703(P<0.001),在OPG=246.93时,约登指数最大为0.431,其对CHF中OP诊断价值最大,其灵敏度及特异度分别为0.769、0.662;在sRANKL=20.275时,约登指数最大为0.385,其对CHF中OP诊断价值最大,其灵敏度及特异度分别为0.635、0.750。结论监测血清OPG、sRANKL水平可能有助于发现CHF患者OP,为临床诊治CHF合并OP提供重要的参考。

Objective To observe the expression of serum osteoprotegerin(OPG)and soluble receptor activator of nuclear factor-κB ligand(sRANKL)levels in patients with chronic heart failure(CHF),and to explore the relationship between those and osteoporosis in CHF patients,providing value for the diagnose and intervention of CHF patients with osteoporosis.Methods CHF patients hospitalized from January 2020 to August 2021 were selected to detect serum OPG and sRANKL and bone mineral density(BMD)levels.They were divided into non-osteoporosis group and osteoporosis group according to bone mass.The serum OPG and sRANKL levels and their correlation with bone mineral density were compared between the two groups.The diagnostic value of OPG and sRANKL levels in CHF patients with osteoporosis was analyzed.Results(1)Serum levels of OPG and sRANKL in CHF patients with osteoporosis were higher than those in CHF patients without osteoporosis,and the differences were statistically significant(P<0.001).(2)Serum OPG and sRANKL levels were negatively correlated with BMD in CHF patients(r=-0.595/-0.458,P<0.001).(3)Serum OPG and sRANKL were risk factors for osteoporosis in CHF patients(OR=1.004,P=0.005;OR=1.061,P=0.011).(4)ROC curve was used to analyze the predictive value of serum OPG and sRANKL levels on osteoporosis in CHF patients.The area under ROC curve(AUC)was 0.761 and 0.703,respectively(P<0.001).When OPG=246.93,the highest Youden index was 0.431,which had the greatest diagnostic value for osteoporosis in CHF.The sensitivity and specificity were 0.769 and 0.662,respectively.When sRANKL=20.275,the Youden index was 0.385,and the sensitivity and specificity were 0.635 and 0.750,respectively,which had the greatest diagnosis value for osteoporosis in CHF.Conclusion Monitoring serum OPG and sRANKL levels may be helpful to detect osteoporosis in patients with CHF,providing an important reference for clinical diagnosis and treatment of CHF combined with osteoporosis.