骨保护素与冠心病合并糖尿病患者冠状动脉支架内再狭窄的关系

目的探讨血清骨保护素(OPG)与冠心病合并糖尿病患者冠状动脉介入术后支架内再狭窄(ISR)的关系。方法在行经皮冠状动脉介入治疗并于约1年后行冠状动脉造影复查的1 652例糖尿病患者中,135例为ISR患者(ISR组),从其余患者中随机选取85例无ISR的冠心病合并糖尿病患者作为对照(无ISR组)。检测血清OPG水平及生物化学指标,并收集患者的临床资料。通过多变量Logistic回归分析发生ISR的独立危险因素。结果 ISR组血清OPG水平显著高于无ISR组(P<0.001)。与无ISR组相比,ISR组患者的吸烟发生率更高,血清肌酐、总胆固醇、高敏C反应蛋白、低密度脂蛋白胆固醇水平更高,冠状动脉病变更严重,累及的血管更多,肾小球滤过率更低,使用降糖药物治疗患者更少,支架直径更小(P均<0.05)。将血清OPG水平按三分位数分组,在校正了可能的混杂因素后,多变量Logistic回归分析显示血清OPG高水平组发生ISR的风险是低水平组的5.349倍(OR=5.349,95%CI为2.049～13.967,P=0.001),中水平组发生ISR的风险是低水平组的2.711倍(OR=2...

Relationship between osteoprotegerin and in-stent restenosis in patients with coronary heart disease complicated with diabetes after percutaneous coronary intervention

Aim To investigate the relationship between serum osteoprotegerin(OPG)and in-stent restenosis(ISR)in patients with coronary heart disease complicated with diabetes after percutaneous coronary intervention(PCI).Methods From 1652 diabetes patients undergoing PCI and follow-up angiography at approximately one year,135 patients were diagnosed with ISR,while 85 patients without ISR were randomly included as controls.Serum OPG levels and biochemical indexes were examined.General clinical data of the study subjects were collected.Multivariable Logistic regression was used to analyze the independent risk factors of ISR.Results Serum OPG levels were significantly higher in patients with ISR than those without ISR(P<0.001).Patients with ISR had higher rates of smoking,higher values of serum creatinine,total cholesterol,low density lipoprotein cholesterol(LDLC)and high sensitivity C-reactive protein(hs-CRP),lower values of glomerular filtration rate(GFR),more involved vessels,more severe lesions in coronary arteries,less treatment of dual antiplatelet therapy,diabetes control drugs and statins,and smaller stent diameter as compared with patients without ISR(all P<0.05).The patients were further divided based upon the tertile distribution of OPG.Multivariable Logistic regression analysis showed that OPG level was an independent determinant of ISR with an odds ratio of 5.349(95%CI:2.049~13.967,P=0.001)and 2.711(95%CI:1.095~6.710,P=0.031)for tertile 3 and 2 compared with tertile 1 after correction of possible confounding factors.Conclusion Serum OPG level is associated with the presence of ISR,and it is an independent risk factor of ISR in diabetes patients.