绝经后女性骨代谢标志物与冠心病、冠状动脉粥样硬化病变程度相关性的初步研究  

Association of bone metabolic markers with coronary artery disease and coronary arthrosclerosis in postmenopausal women

作　　者：吴冰洁[1] 蒋晶晶[1] 李晓牧[1] 凌雁[1] 高鑫[1] 

机构地区：[1]复旦大学附属中山医院内分泌代谢科,上海200032

出　　处：《中华内分泌代谢杂志》2016年第11期928-933,共6页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的：比较绝经后女性冠心病和非冠心病患者各种骨代谢标志物的差异,分析骨代谢标志物是否为绝经后女性冠心病的独立危险因素。方法以因可疑冠心病在复旦大学附属中山医院心内科行冠状动脉造影的绝经后女性患者为研究对象,选取60例冠脉造影证实的冠心病患者作为病例组,60例冠脉造影阴性的患者作为对照组。完成标准化问卷,常规生化指标、骨代谢标志物包括甲状旁腺素（ PTH）、25-羟维生素D3[25（OH）D3]、血清Ⅰ型胶原交联C端肽（CTX）、Ⅰ型原胶原氨基末端前肽（PINP）和骨钙素的测定。结果与对照组相比,冠心病组CTX水平显著降低（P〈0.05）。根据CTX三分位分层,随着CTX水平增加,冠心病比例逐层减少（分别为70%、50%和30%）。以第一分位层为参照,校正年龄、体重指数、吸烟史、收缩压、舒张压、糖尿病史、高血压史、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、eGFR,冠心病风险的OR值在第三分位层显著降低（OR=0.05,95%CI 0.01~0.43, P=0.01）。多元线性回归分析显示CTX与Gensini评分独立负相关（β=-55.19,95%CI-106.47^-3.90,P=0.04）。 PTH、25（OH）D3、PINP、骨钙素与冠心病及Gensini评分无独立相关性。结论绝经后女性血清CTX水平降低与冠心病独立相关,且CTX水平与冠状动脉粥样硬化病变程度呈负相关。Objective The aim of this study was to examine the relationship between bone metabolic markers and coronary artery disease（ CAD） and coronary atherosclerosis in postmenopausal women. Methods Subjects were the postmenopausal women who were admitted to the Department of Cardiology of Zhongshan Hospital for suspected CAD and underwent coronary angiography. 60 angiography confirmed CAD subjects and 60 angiography confirmed non-CAD subjects were recruited in the current study. A standard questionnaire was completed for each participant. Biochemical parameters and bone metabolic markers including parathyroid hormone （ PTH ） , 25-hydroxyvitamin D3[25（OH）D3], typeⅠcollagen cross-linked C-telopeptide（CTX）, typeⅠprocollagen amino-terminal peptide（ PINP） , and osteocalcin were determined. Results Serum CTX levels were significantly decreased in the CAD group compared with those of non-CAD group（P〈0. 05）. The proportion of CAD decreased across the CTX tertiles（70%, 50%, and 30%, respectively, P=0. 04）. After adjustment by age, body mass index, smoking, systolic blood pressure, diastolic blood pressure, diabetes, hypertension, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and estimated glomerular filtration rate, the risk of CAD significantly decreased in the third CTX tertile compared to the first CTX tertile（OR=0. 05, 95% CI 0. 01-0. 43, P=0. 01）. Multivariate linear regression analysis showed that serum CTX was independently associated with the Gensini score（β=-55. 19, 95%CI-106. 47--3. 90, P=0. 04）. However, PTH, 25（OH）D3, PINP, and osteocalcin were not associated with CAD or the Gensini score. Conclusion Serum CTX was independently associated with CAD as well as the severity of coronary arthrosclerosis in postmenopausal women.

关 键 词：骨代谢标志物 冠状动脉粥样硬化性心脏病 GENSINI评分 

分 类 号：R541.4[医药卫生—心血管疾病]