CAJ | 학술논문

目的探讨骨保护素(OPG)系统在急性冠脉综合征(ACS)发病中的作用及与ACS中医辨证分型的关系.方法采用前瞻性研究方法,选取ACS患者210例、稳定型心绞痛(SAP)患者200例,用酶联免疫吸附试验(ELISA)检测血清OPG及其配体(sRANKL)水平,比较分析二者及其比值(OPG/sRANKL)在冠状动脉(冠脉)病变支数、中医辨证分型中的意义.以150例非冠心病患者为对照.结果 ACS组和SAP组血清OPG、OPG/sRANKL明显高于对照组,sRANKL明显低于对照组(均P＜0.01)；且ACS组OPG、OPG/sRANKL较SAP组升高更为显著(均P＜0.01).不同冠脉病变支数的ACS患者血清OPG、OPG/sRANKL水平均显著高于对照组,sRANKL显著低于对照组(均P＜0.01)；且ACS患者随着冠脉病变支数的增多,OPG、OPG/sRANKL逐渐升高,而sRANKL水平则逐渐降低(P＜0.05或P＜0.01).不同中医证型的ACS患者血清OPG及OPG/sRANKL均为阳气虚衰证＞气滞血瘀证＞气虚血瘀证＞痰阻心脉证＞心肾阴虚证＞气阴两虚证,其中阳气虚衰证、气滞血瘀证均较气阴两虚证显著升高[OPG (ng/L):621.38±32.86、617.63±39.60比593.86±36.19,OPG/sRANKL(g/mol):1 018.98±106.03、1 011.27± 121.61比942.16±115.82,P＜0.05或P＜0.01]；而各中医证型ACS患者血清sRANKL水平均明显低于对照组(均P＜0.01),但各证型间sRANKL水平差异无统计学意义(均P＞0.05).结论血清OPG、sRANKL、OPG/sRANKL水平与ACS发病及冠脉病变严重程度有一定相关性；血清OPG、OPG/sRANKL比值与ACS阳气虚衰证、气滞血瘀证存在一定相关性.
목적 탐토골보호소(OPG)계통재급성관맥종합정(ACS)발병중적작용급여ACS중의변증분형적관계.방법 채용전첨성연구방법,선취ACS환자210례、은정형심교통(SAP)환자200례,용매련면역흡부시험(ELISA)검측혈청OPG급기배체(sRANKL)수평,비교분석이자급기비치(OPG/sRANKL)재관상동맥(관맥)병변지수、중의변증분형중적의의.이150례비관심병환자위대조.결과 ACS조화SAP조혈청OPG、OPG/sRANKL명현고우대조조,sRANKL명현저우대조조(균P＜0.01)；차ACS조OPG、OPG/sRANKL교SAP조승고경위현저(균P＜0.01).불동관맥병변지수적ACS환자혈청OPG、OPG/sRANKL수평균현저고우대조조,sRANKL현저저우대조조(균P＜0.01)；차ACS환자수착관맥병변지수적증다,OPG、OPG/sRANKL축점승고,이sRANKL수평칙축점강저(P＜0.05혹P＜0.01).불동중의증형적ACS환자혈청OPG급OPG/sRANKL균위양기허쇠증＞기체혈어증＞기허혈어증＞담조심맥증＞심신음허증＞기음량허증,기중양기허쇠증、기체혈어증균교기음량허증현저승고[OPG (ng/L):621.38±32.86、617.63±39.60비593.86±36.19,OPG/sRANKL(g/mol):1 018.98±106.03、1 011.27± 121.61비942.16±115.82,P＜0.05혹P＜0.01]；이각중의증형ACS환자혈청sRANKL수평균명현저우대조조(균P＜0.01),단각증형간sRANKL수평차이무통계학의의(균P＞0.05).결론 혈청OPG、sRANKL、OPG/sRANKL수평여ACS발병급관맥병변엄중정도유일정상관성；혈청OPG、OPG/sRANKL비치여ACS양기허쇠증、기체혈어증존재일정상관성.
Objective To investigate the relationship between osteoprotegerin (OPG) system and acute coronary syndrome (ACS) and its classification according to traditional Chinese medicine (TCM).Methods A prospective study was conducted.The patients with ACS (n =210) and the patients with stable angina pectoris (SAP,n=200) were enrolled.The serum OPG and its ligand (sRANKL) were determined by enzyme-linked immunosorbent assay (ELISA),the OPG/sRANKL ratio was calculated,and the number of coronary vessels was involued,finally their relationship with the typing according to TCM was evaluated.One hundred and fifty non-coronary heart disease patients were enrolled as control.Results The serum OPG,OPG/sRANKL in ACS and SAP groups were significantly higher than those in control group,and the sRANKL was significantly lower than that in control group (all P＜0.01).The OPG,OPG/sRANKL in ACS groups were significantly higher than those in SAP group （both P ＜0.01).Serum OPG,OPG/sRANKL in ACS patients with different number of coronary vessel disease were significantly higher than those in control group,and the sRANKL was significantly lower than that in control group (all P ＜0.01).OPG and OPG/sRANKL were gradually increased with increase in number of diseased coronary vessels,but the sRANKL descended (P＜0.05 or P＜0.01).Serum OPG and OPG/sRANKL were descended according to dialectical classification of TCM:Yang Q i weakening syndrome ＞ Qi and blood stagnation syndrome ＞ Qi deficiency with blood stasis syndrome ＞stagnation of phlegm blocks the heart-vessels syndrome ＞Yin deficiencies of the heart and the kidney syndrome ＞deficiency of both Qi and Yin syndrome,among them they were significantly higher in Yang Qi failure syndrome and Qi and blood stagnation syndromes than those of both Qi and Yin syndrome [OPG(ng/L):621.38 ± 32.86,617.63 ± 39.60vs.593.86 ± 36.19,OPG/sRANKL (g/mol):1 018.98 ± 106.03,1 011.27 ± 121.61 vs.942.16 ± 115.82,P＜0.05 or P＜0.01].Among different types of TCM in ACS group the serum sRANKL was significantly lower than that in control group (all P ＜0.01),but the difference among different types was not significant.Conclusions Serum OPG,sRANKL,OPG/sRANK levels were related with incldence and severity of coronary lesions in ACS patients.Serum OPG and OPG/sRANKL ratio may have correlation with Yang Qi weakening syndrome and Qi deficiency with blood stasis syndrome.