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目的探讨血清骨保护素水平(OPG)和急性脑梗塞患者颈动脉内皮功能和粥样硬化斑块稳定性的关系。方法急性脑梗死患者120例经颈动脉超声检查颈动脉内膜中层厚度(CIMT),分为不稳定斑块组(61例)和稳定斑块组(59例)。选取健康体检人员60例为对照组。测定各组的血清OPG水平和非对称性二甲基精氨酸(ADMA,内皮功能的一个标志)水平,比较各组的血清OPG和ADMA水平的差异和相关性,多元线性回归分析和多元Logistic回归分析血清OPG水平与不稳定斑块关系。结果不稳定斑块组血清OPG水平>稳定斑块组>正常对照组,差异均具有统计学意义(P<0.05)。不稳定斑块组血清ADMA水平>稳定斑块组>正常对照组,差异均具有统计学意义(P<0.05)。不稳定斑块组、稳定斑块组和对照组的血清OPG与ADMA水平均呈正相关(P<0.05)。不稳定斑块多元线性回归分析,显示血清OPG和ADMA水平是不稳定斑块独立决定因素(β1=0.245,P=0.020;β2=0.240,P=0.026)。多元Logistic回归分析显示,血清OPG水平与不稳定斑块密切相关(OR:2.65,95%CI:1.13-6.98,P=0.014)。结论血清OPG水平可能与急性脑梗死患者颈动脉内皮功能异常和粥样斑块不稳定性密切相关。
Objective To investigate the relationship between serum osteoprotegerin (OPG) levels and carotid endothelial dysfunction and atherosclerotic plaque stability in patients with acute cerebral infarction. Methods Totally 120 patients with acute cerebral infarction underwent carotid ultrasonography to detect carotid intima-media thickness (CIMT). The patients were divided into unstable plaque group (61 cases) and stable plaque group (59 cases). 60 healthy people were selected as the control group. Serum levels of OPG and asymmetric dimethylarginine (ADMA, a marker of endothelial function) were determined in each group, and the differences and correlations between serum OPG and ADMA levels, the multiple linear regression analysis and multivariate Logistic Regression analysis of the relationship between serum OPG level and unstable plaque. Results In the unstable plaque group, serum OPG level> stable plaque group> normal control group, the differences were statistically significant (P <0.05). In the unstable plaque group, serum ADMA levels> stable plaque group> normal control group, the differences were statistically significant (P <0.05). The levels of OPG and ADMA in unstable plaque group, stable plaque group and control group were positively correlated (P <0.05). Multivariate linear regression analysis of unstable plaques showed that serum OPG and ADMA levels were the independent determinants of unstable plaques (β1 = 0.245, P = 0.020; β2 = 0.240, P = 0.026). Multiple logistic regression analysis showed that serum OPG levels were closely related to unstable plaques (OR: 2.65, 95% CI: 1.13-6.98, P = 0.014). Conclusion Serum OPG levels may be closely related to carotid endothelial dysfunction and atherosclerotic plaque instability in patients with acute cerebral infarction.