老年人血清骨硬化蛋白与冠心病及骨质疏松的相关研究

发布时间：2018-06-12 23:11

本文选题：骨硬化蛋白 + 冠状动脉粥样硬化性心脏病　；参考：《重庆医科大学》2017年硕士论文

【摘要】：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,为探索冠心病与骨质疏松相似或相同的病理生理机制提供临床依据,为冠心病与骨质疏松共病治疗提供新思路。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,年龄在60-91岁,其中其中男性患者132例,女性患者181例。根据冠状动脉造影结果将研究对象分为冠心病组(CHD组,n=163)及非冠心病组(非CHD组,n=150),所有患者均行双能X线骨密度仪(DEXA)测定股颈及腰椎BMD值,参照1994年世界卫生组织(WHO)推荐的OP诊断标准,将研究对象分为骨质疏松患者(n=163)与非骨质疏松患者(n=150)。采集研究对象性别、年龄、吸烟史、血压、BMI等一般资料,取术前空腹静脉血用ELISA法测定血清骨硬化蛋白水平,同时测定血清肌酐(Scr)、糖化血红蛋白(Hb A1c)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hs-CRP)等冠心病危险因子以及血钙(Ca2+)、血磷(P)、甲状旁腺激素(PTH)、25-羟基维生素D3(25(OH)Vit D)、骨型碱性磷酸酶(BALP)、I型胶原氨基端延长肽(PINP)、I型胶原羧基端肽β特殊序列(β-CTX)、骨钙素N端片段(N-MID)等骨转换标志物等生化指标分别比较冠心病与非冠心病组间、骨质疏松患者与非骨质疏松间骨硬化蛋白水平,患者采用多因素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[(178.3±6.3)pg/m Lvs(180.4±3.8)pg/m L,P0.05],骨质疏松患者骨硬化蛋白水平较非骨质疏松患者低[(178.8±5.8)pg/m Lvs(180.5±3.9)pg/m L,P0.05],骨质疏松患者中冠心病组(OP+CHD)骨硬化蛋白水平显著低于非冠心病组(OP+非CHD)[(177.4+7.1)pg/m Lvs(180.1+3.4)pg/m L,P=0.018]。非骨质疏松患者中冠心病组(非OP+CHD)骨硬化蛋白水平与非冠心病组(非OP+非CHD)无明显差异(P0.05);(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(P0.05);(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,P0.05)、I型胶原氨基端延长肽(β=0.161,P0.05)、年龄(β=-0.162,P0.05)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。
[Abstract]:Objective: to investigate the correlation between serum osteosclerotic protein (BGP) levels and coronary heart disease (CHD) and osteoporosis (Osteoporosis) in the elderly, so as to provide clinical evidence for exploring the pathophysiological mechanism of CHD and osteoporosis. To provide a new idea for the treatment of coronary heart disease and osteoporosis co-disease. Methods: a total of 313 elderly patients, aged 60-91 years, were enrolled in the Department of Geriatric Cardiovascular Disease of the second affiliated Hospital of Chongqing Medical University from October 2014 to October 2015, who were admitted to hospital for coronary angiography due to chest pain, 132 of whom were male. 181 female patients. According to the results of coronary angiography, the subjects were divided into two groups: coronary heart disease group (CHD group) and non-coronary heart disease group (non-CHD group). All the patients were measured by dual energy X-ray absorptiometry (DEXA). According to the op diagnostic criteria recommended by the World Health Organization (WHO) in 1994, the subjects of the study were divided into osteoporosis patients (n = 163) and non-osteoporosis patients (n = 150). The data of sex, age, smoking history, blood pressure and BMI were collected to determine serum osteosclerotic protein level by Elisa. At the same time, the risk factors of coronary heart disease, such as serum creatinine, glycosylated hemoglobin, triglyceride, total cholesterol, high density lipoprotein (HDL-C), low density lipoprotein cholesterol (LDL-C), hypersensitive C-reactive protein (hs-CRP), and serum calcium, phosphophosphate, triglyceride, and so on, were also determined. The changes of bone markers, such as PTHH, 25-hydroxyvitamin D _ (35) and Vit D, bone type alkaline phosphatase (BALP), type I collagen amino terminal prolongation peptide (PINPU), type I collagen carboxyl terminal peptide 尾 (尾 -CTX), osteocalcin N-terminal fragment N-MIDand, and other biochemical markers were compared respectively. Between diseased and non-coronary heart disease groups, The correlation between bone sclerosing protein level and coronary heart disease was analyzed by multivariate logistic regression model. Multiple linear regression analysis was used to analyze the correlation factors of bone sclerosing protein level between osteoporosis patients and non-osteoporosis patients. Results the level of bone sclerosing protein in the aged patients with coronary heart disease was significantly lower than that in the non-coronary heart disease group [178.3 卤6.3)pg/m vs 180.4 卤3.8)pg/m P 0.05], and the level of bone sclerosing protein in the patients with osteoporosis was lower than that in the patients with non-osteoporosis [178.8 卤5.8)pg/m vs 180.5 卤3.9)pg/m P 0.05], and the osteosclerotic eggs of the patients with osteoporosis in the coronary heart disease group were significantly lower than those in the patients with osteoporosis. White level was significantly lower than that in non-CHD group (P < 0. 018). There was no significant difference in bone sclerosing protein levels between coronary heart disease (non-op) group and non-op non-CHD group (non-op non-CHD2) by multivariate logistic regression analysis. The results of multivariate logistic regression suggested that bone sclerosing protein was negatively correlated with coronary heart disease (CHD) in elderly patients. The increase of bone sclerosing protein level in patients with osteoporosis can reduce the risk of coronary heart disease. In non-osteoporosis patients, bone sclerosing protein is not correlated with coronary heart disease (P 0.05). The multiple linear regression suggests that bone sclerosis protein level and lumbar bone mineral density (尾 0.224g / P 0.05I) are associated with osteoporosis. Collagen amino terminal prolongation peptide (尾 -0.161) was significantly correlated with age (尾 -0.162 P 0.05). Conclusion: serum osteosclerotic protein is closely related to the occurrence of coronary heart disease in elderly patients, especially in elderly patients with osteoporosis, and may play a messenger role in the osseous and vascular axis.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4;R580

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