本文選題：骨硬化蛋白 + 冠狀動脈粥樣硬化性心臟病　； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討老年人血清骨硬化蛋白水平與冠心病及骨質(zhì)疏松的相關(guān)性,為探索冠心病與骨質(zhì)疏松相似或相同的病理生理機制提供臨床依據(jù),為冠心病與骨質(zhì)疏松共病治療提供新思路。方法:入選重慶醫(yī)科大學(xué)附屬第二醫(yī)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狀動脈造影的老年患者313例,年齡在60-91歲,其中其中男性患者132例,女性患者181例。根據(jù)冠狀動脈造影結(jié)果將研究對象分為冠心病組(CHD組,n=163)及非冠心病組(非CHD組,n=150),所有患者均行雙能X線骨密度儀(DEXA)測定股頸及腰椎BMD值,參照1994年世界衛(wèi)生組織(WHO)推薦的OP診斷標(biāo)準,將研究對象分為骨質(zhì)疏松患者(n=163)與非骨質(zhì)疏松患者(n=150)。采集研究對象性別、年齡、吸煙史、血壓、BMI等一般資料,取術(shù)前空腹靜脈血用ELISA法測定血清骨硬化蛋白水平,同時測定血清肌酐(Scr)、糖化血紅蛋白(Hb A1c)、甘油三酯(TG)、總膽固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白膽固醇(LDL-C)、超敏C反應(yīng)蛋白(hs-CRP)等冠心病危險因子以及血鈣(Ca2+)、血磷(P)、甲狀旁腺激素(PTH)、25-羥基維生素D3(25(OH)Vit D)、骨型堿性磷酸酶(BALP)、I型膠原氨基端延長肽(PINP)、I型膠原羧基端肽β特殊序列(β-CTX)、骨鈣素N端片段(N-MID)等骨轉(zhuǎn)換標(biāo)志物等生化指標(biāo)分別比較冠心病與非冠心病組間、骨質(zhì)疏松患者與非骨質(zhì)疏松間骨硬化蛋白水平,患者采用多因素logistic回歸模型分析骨硬化蛋白水平與冠心病發(fā)生的相關(guān)性,用多元線性回歸分析影響骨硬化蛋白水平的相關(guān)因素。結(jié)果:(1)老年冠心病組骨硬化蛋白水平顯著低于非冠心病組[(178.3±6.3)pg/m Lvs(180.4±3.8)pg/m L,P0.05],骨質(zhì)疏松患者骨硬化蛋白水平較非骨質(zhì)疏松患者低[(178.8±5.8)pg/m Lvs(180.5±3.9)pg/m L,P0.05],骨質(zhì)疏松患者中冠心病組(OP+CHD)骨硬化蛋白水平顯著低于非冠心病組(OP+非CHD)[(177.4+7.1)pg/m Lvs(180.1+3.4)pg/m L,P=0.018]。非骨質(zhì)疏松患者中冠心病組(非OP+CHD)骨硬化蛋白水平與非冠心病組(非OP+非CHD)無明顯差異(P0.05);(2)多因素logistic回歸提示老年患者骨硬化蛋白與冠心病發(fā)生負相關(guān)(OR=0.865,P=0.018),其中骨質(zhì)疏松患者骨硬化蛋白水平升高可降低罹患冠心病的風(fēng)險(OR=0.767,P=0.007),非骨質(zhì)疏松患者骨硬化蛋白與冠心病無相關(guān)性(P0.05);(3)多元線性回歸提示骨硬化蛋白水平與腰椎骨密度(β=0.224,P0.05)、I型膠原氨基端延長肽(β=0.161,P0.05)、年齡(β=-0.162,P0.05)顯著相關(guān)。結(jié)論:血清骨硬化蛋白與老年患者尤其是合并骨質(zhì)疏松的老年患者冠心病發(fā)生密切相關(guān),并可能在骨-血管軸中發(fā)揮信使作用。
[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 鹵6.3)pg/m vs 180.4 鹵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 鹵5.8)pg/m vs 180.5 鹵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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4;R580

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本文編號：2011453