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目的:探讨急性冠脉综合征(ACS)患者血清骨保护素(osteoprotegerin,OPG)及其配体(souble-RANKL,sRANKL)和OPG/sRANKL比值与冠状动脉粥样硬化稳定程度的相关性。方法:纳入研究者分成3组:ACS患者(335例)、稳定型心绞痛(SAP)患者(120例)与正常对照组(120例)。其中ACS组又分为不稳定心绞痛(UAP组)134例,非ST段抬高型心肌梗死(NSTEMI组)80例以及ST段抬高型心肌梗死(STEMI)组121例3组。通过ELISA检测其血清OPG和sRANKL水平,并将二者血清水平及比值(OPG/sRANKL)与ACS冠状动脉粥样硬化斑块稳定程度进行比较分析。结果:ACS、SAP及对照组3组间血清OPG、sRANKL、OPG/sRANKL比值均有显著差异(均P<0.01)。ACS组内3组血清OPG、sRANKL、OPG/sRANKL比值也均有显著差异(均P<0.05),其中STEMI组与UAP组有显著差异(P<0.05),UAP组与NSTEMI组、NSTEMI与STEMI组间无显著差异。冠脉Gensini积分与血清OPG水平呈正相关(r=0.252,P<0.01),与OPG/sRANKL呈正相关(r=0.284,P<0.01),与血清sRANKL水平呈负相关(r=-0.235,P<0.05)。结论:血清OPG、sRANKL、OPG/sRANK比值与ACS病情及冠状动脉粥样硬化斑块稳定程度有关联。
Objective: To investigate the correlation between the serum levels of souble OPG and sRANKL and OPG / sRANKL and the stability of coronary atherosclerosis in patients with acute coronary syndrome (ACS). METHODS: The included subjects were divided into 3 groups: ACS (n = 335), stable angina pectoris (SAP) (n = 120) and control group (n = 120). The ACS group was divided into unstable angina (UAP group) 134 cases, non-ST-segment elevation myocardial infarction (NSTEMI group) 80 cases and ST-segment elevation myocardial infarction (STEMI) group 121 cases and 3 groups. Serum levels of OPG and sRANKL were measured by ELISA. The levels of OPG / sRANKL and the level of serum atherosclerotic plaque in ACS were compared with each other. Results: The serum OPG, sRANKL, OPG / sRANKL ratios of ACS, SAP and control group were significantly different (all P <0.01). The serum OPG, sRANKL and OPG / sRANKL ratios in the three groups were also significantly different (all P <0.05), and there was significant difference between STEMI group and UAP group (P <0.05). There was significant difference between UAP group and NSTEMI group, NSTEMI and STEMI No significant difference between groups. Coronary Gensini score was positively correlated with serum OPG level (r = 0.252, P <0.01), positively correlated with OPG / sRANKL (r = 0.284, P <0.01) and negatively correlated with serum sRANKL level <0.05). Conclusion: The serum levels of OPG, sRANKL and OPG / sRANK are correlated with the severity of ACS and the stability of coronary atherosclerotic plaque.