老年人骨代谢状态指标与动脉粥样硬化性疾病的相关性研究  

Correlation between bone metabolism and atherosclerotic disease in elderly

作　　者：王翠霞 章晓炎[1] 巩云霞[1] 吴方[1] WANG Cuixia;ZHANG Xiaoyan;GONG Yunxio;WU Fang(Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, Chin)

机构地区：[1]上海交通大学医学院附属瑞金医院老年病科,上海200025

出　　处：《诊断学理论与实践》2017年第6期633-638,共6页Journal of Diagnostics Concepts & Practice

基　　金：基金项目:上海市卫生计生系统重要薄弱学科建设(2015ZB0503)

摘　　要：目的 :探讨老年人血清25-羟维生素D(25-hydroxy vitamin D,25-OH-D)、骨保护素(osteoprotegerin,OPG)、甲状旁腺素(parathyroid,PTH)、Ⅰ型胶原氨基端肽(procollagen type 1 N-terminal propeptide,P1NP)、Ⅰ型胶原羧基端肽交联(βcross-linked C-telopeptide of type 1 collagen,β-CTX)等骨代谢指标与动脉粥样硬化疾病间的相关性。方法:入选2015年1月至2016年10月上海交通大学医学院附属瑞金医院老年病科的163例患者,分为动脉粥样硬化组(110例)及对照组(53例),动脉粥样硬化组包括外周动脉粥样硬化组60例、冠心病组25例及脑梗死组25例。测量其血压,计算体质量指数,测定肾功能、血糖、血脂、C-反应蛋白(CRP)、25-OH-D、OPG、PTH、P1NP、β-CTX,并采用彩色多普勒超声仪行颈及下肢动脉超声检查,比较动脉粥样硬化性疾病组与对照组间的骨代谢指标变化。结果:(1)163例患者的平均血清25-OH-D含量为(47.11±17.29)nmol/L,维生素D缺乏者占58.1%。(2)与对照组相比,动脉粥样硬化性疾病组的25-OH-D含量明显降低(P<0.05),血清OPG、PTH水平则显著升高(P<0.05)。(3)相关分析提示,动脉粥样硬化性疾病与25-OH-D含量呈负相关(r=-0.559,P<0.05),与OPG水平呈正相关(r=0.459,P<0.05);而P1NP、β-CTX含量与动脉粥样硬化间无相关性(P>0.05)。(4)Logistic回归分析结果提示,血清25-OH-D和OPG是动脉粥样硬化性疾病的独立相关因素。结论 :动脉粥样硬化性疾病患者的血清25-OH-D含量明显降低,早期补充维生素D或可一定程度上减缓其动脉粥样硬化性疾病进展。血清OPG水平在动脉粥样硬化性疾病患者中显著升高可能是机体的代偿性保护作用。骨转换高低与动脉粥样硬化无关,但需要更进一步研究以证实。Objective： To investigate the correlation of indicators of bone metabolism including hydroxyvitamin D（25-OH-D）, osteoprotegerin（OPG）, parathyroid（PTH）, procollagen type 1 N-terminal propeptide（P1 NP）, β cross-linked Ctelopeptide of type 1 collagen（β-CTX）with atherosclerotic disease in elderly. Methods： A total of 163 elderly patients at Department of Geriatrics, Ruijin Hospital from January 2015 to October 2016（mean age 75.8 years）were recruited. Blood pressure, BMI, plasma glucose, renal function, blood lipids, CRP, 25-OH-D, OPG, PTH, P1 NP, β-CTX were measured.Both carotid and lower extremity atherosclerosis were assessed by Doppler ultrasound,and patients were divided into 2 groups： atherosclerosis group and control group. Results：（1）The mean serum level of 25-OH-D in all subjects was（47.11±17.29） nmol/L and the percentage of vitamin D deficiency was 58.1%.（2）Compared with the control group, serum 25-OHD in atherosclerosis group was significantly lower(P 〈0.05）, while OPG and PTH were significantly higher(P 〈0.05）.（3）Atherosclerotic disease was negatively correlated with 25-OH-D（r=-0.559, P〈0.05）and positively correlated with OPG（r=0.459, P〈0.05）by correlation analysis.（4）Logistic regression analysis showed that serum 25-OH-D and OPG were independent risk factors of atherosclerotic disease. Conclusions： Patients with atherosclerotic disease have lower serum 25-OH-D level. Early vitamin D supplementation may slow down the progression of atherosclerosis. The significantly higher serum OPG in patients with atherosclerotic disease may be due to the compensatory protective effect of body. This study reveales that status of bone turnover has no relationship with atherosclerosis, yet needs to be further investigated.

关 键 词：老年人 25-羟维生素D 骨保护素 骨代谢 动脉粥样硬化 

分 类 号：R543[医药卫生—心血管疾病]