目的 探讨血清护骨素(OPG)水平与冠心病合并慢性肾功能不全患者冠脉病变程度及近期预后的关系.方法 202例慢性肾功能不全住院患者,根据冠脉造影结果分为冠脉正常或轻度粥样硬化组51例(D组),单支病变组52例(A组),双支病变组51例(B组),三支病变组48例(C组).ELISA法检测血清OPG水平,并分析其与冠脉病变程度、高血压、糖尿病、肾功能不全之间的关系.对患者进行1年随访,记录主要终点事件:再发急性冠脉综合征、心源性死亡、病死率、缺血性中风、发展为尿毒症期或维持透析.结果 血清OPG水平随冠脉病变支数增加而升高.D组、A组、B组和C组血清OPG水平分别为(205.42±86.18) ng/L、(284.98±183.30) ng/L、(322.56±161.95) ng/L和(430.95±211.92) ng/L(P＜0.01).随访(14.7±1.2)个月.14例(7.3％)患者达到终点事件,血清OPG水平为(428.96±197.13) ng/L,高于未发生事件者的(303.10±182.75)ng/L(P＜0.05).结论 冠心病合并慢性肾功能不全患者,OPG水平越高,冠脉病变程度越严重,近期预后越差.%Objective To examine whether serum osteoprotegerin (OPG) levels are associated with the severity of coronary artery lesions and 1-year prognosis. Methods Serum OPG levels were examined by ELISA kit in 202 patients with chronic renal insufficiency who underwent coronary angiography. The number of diseased vessels was used to represent the severity of coronary artery disease (CAD). The patients were divided into four groups of D (normal coronary arteries and mild coronary atherosclerosis),A( 1-vessel lesion),B(2-vessel lesion) and C(3-vessel lesion). The patients were followed up for average 14 months. The endpoints included recurrence of acute coronary syndrome,cardiac death, total mortality, ischemic stroke, uremia and dialysis. Results The serum OPG levels increased as CAD became severe, which were (205. 42±86.18) ng/L in group D, (284. 98 ±183. 30) ng/L in group A, (322. 56± 161. 95) ng/L in group B,and (430. 95 ±211. 92) ng/L in group C(P<0. 01). A total of 14 (7. 3%) cases occurred the endpoints with a higher OPG of (428. 96 ±197.13) ng/L, which was higher than (303.10 ± 182. 75) ng/L in those did not (P<0. 05). Conclusion In CAD patients with chronic renal insufficiency,the higher OPG levels,the severer CAD disease and poorer the short-term prognosis.
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