血清骨硬化蛋白和护骨素水平与急性心肌梗死患者的存在、严重程度和预后的关系。
Association of serum sclerostin and osteoprotegerin levels with the presence, severity and prognosis in patients with acute myocardial infarction.
机构信息
Department of Cardiovascular Medicine, The Third Affiliated Hospital, SunYat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China.
Department of Cardiac Care Unit, The Third Affiliated Hospital, SunYat-Sen University, Guangzhou, China.
出版信息
BMC Cardiovasc Disord. 2022 May 11;22(1):213. doi: 10.1186/s12872-022-02654-1.
BACKGROUND
Bone-related proteins (such as sclerostin and osteoprotegerin [OPG]) are involved in the development of atherosclerosis. However, the relationship between bone-related proteins and acute myocardial infarction (AMI) has not been extensively evaluated. The purpose of this study was to assess the association of serum sclerostin and OPG with the presence, severity and prognosis in patients with AMI.
METHODS
This study prospectively enrolled 152 patients attacked by acute chest pain. Serum sclerostin and OPG were detected within the first 24 h after AMI diagnosis by ELISA kits. The AMI predictive efficacy of sclerostin and OPG were analyzed by receiver operating characteristics (ROC) curve. Univariable and multivariable linear regression analyses were performed to determine the association between bone-related proteins and scores indicating the severity of coronary artery occlusion. Moreover, prognostic values were assessed by Kaplan-Meier curves and Cox regression analysis.
RESULTS
There were 92 patients in AMI group, 60 in non-AMI group. Serum levels of sclerostin and OPG were significantly higher in AMI group than in non-AMI group (all p < 0.001), which showed predictive value for the presence of AMI (all p < 0.001). The area under the ROC curve values of sclerostin and OPG were 0.744 and 0.897, respectively. A multivariable linear regression analysis demonstrated that Ln-transformed sclerostin (β = 0.288, p = 0.009) and Ln-transformed OPG (Ln-OPG: β = 0.295, p = 0.019) levels were associated with GENISINI score, independently of conventional clinical parameters. In addition, Ln-OPG levels were still positively associated with GRACE score after adjustments (β = 0.320, p = 0.001). During a 1-year follow-up, patients above the median of sclerostin levels had higher incidence of major adverse cardiac events (MACE) than those below the median (p = 0.028). It was also observed that the MACE rates were higher in patients above the median of OPG levels, though no statistic importance (p = 0.060). After adjusting conventional risk factors by multivariate Cox regression, Ln-OPG was associated with incident MACE (hazard ratio = 2.188 [95% confidence intervals 1.102-4.344], p = 0.025).
CONCLUSIONS
Bone-related proteins could exert a potential role in early risk stratification and prognosis assessment in patients with AMI.
背景
骨相关蛋白（如硬化蛋白和骨保护素[OPG]）参与动脉粥样硬化的发生。然而，骨相关蛋白与急性心肌梗死（AMI）之间的关系尚未得到广泛评估。本研究旨在评估血清硬化蛋白和 OPG 与 AMI 患者的存在、严重程度和预后的关系。
方法
本研究前瞻性纳入了 152 例因急性胸痛就诊的患者。采用 ELISA 试剂盒在 AMI 诊断后 24 小时内检测血清硬化蛋白和 OPG。通过受试者工作特征（ROC）曲线分析硬化蛋白和 OPG 的 AMI 预测效能。采用单变量和多变量线性回归分析来确定骨相关蛋白与冠状动脉闭塞严重程度评分之间的关系。此外，通过 Kaplan-Meier 曲线和 Cox 回归分析评估预后价值。
结果
AMI 组 92 例，非 AMI 组 60 例。AMI 组血清硬化蛋白和 OPG 水平明显高于非 AMI 组（均 p<0.001），对 AMI 的存在具有预测价值（均 p<0.001）。ROC 曲线下面积值显示硬化蛋白和 OPG 的 AUC 值分别为 0.744 和 0.897。多变量线性回归分析表明，Ln 转化的硬化蛋白（β=0.288，p=0.009）和 Ln 转化的 OPG（Ln-OPG：β=0.295，p=0.019）水平与 GENISINI 评分独立相关，不受常规临床参数的影响。此外，调整后 Ln-OPG 水平仍与 GRACE 评分呈正相关（β=0.320，p=0.001）。在 1 年随访期间，硬化蛋白水平中位数以上的患者发生主要不良心脏事件（MACE）的发生率高于中位数以下的患者（p=0.028）。虽然没有统计学意义（p=0.060），但也观察到 OPG 水平中位数以上的患者 MACE 发生率更高。多变量 Cox 回归调整常规危险因素后，Ln-OPG 与 MACE 事件相关（危险比=2.188[95%置信区间 1.102-4.344]，p=0.025）。
结论
骨相关蛋白可能在 AMI 患者的早期风险分层和预后评估中发挥潜在作用。
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