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Osteoprotegerin: a novel independent marker for silent myocardial ischemia in asymptomatic diabetic patients.
骨保护素: 无症状糖尿病患者无症状心肌缺血的新型独立标志物。

摘要

OBJECTIVE:We sought to evaluate osteoprotegerin, an inhibitor of osteoclastogenesis involved in atherosclerosis, and other novel risk factors as predictive markers of silent myocardial ischemia (SMI).
RESEARCH DESIGN AND METHODS:A total of 465 consecutive diabetic patients with more than one additional risk factor were evaluated for SMI using stress myocardial perfusion imaging (MPI). We studied the association of SMI (positive stress electrocardiogram and/or abnormal MPI) with osteoprotegerin, other novel risk factors (lipoprotein[a], homocysteine, adiponectin, C-reactive protein, and fibrinogen), and conventional risk factors (total, LDL, and HDL cholesterol and triglycerides).
RESULTS:A total of 92 patients were diagnosed with SMI. Of the six novel markers, osteoprotegerin was the only one associated with SMI; the relative risk (RR) of SMI in patients with osteoprotegerin values above the 75th percentile was 3.19 (95% CI 1.99-5.18; P < 0.001) in comparison with those with osteoprotegerin below the 75th percentile. In univariate analyses, the other plasma markers significantly associated with SMI were higher triglycerides (P = 0.04) and lower HDL cholesterol (P = 0.02). The association of osteoprotegerin with SMI remained significant after correcting for other variables associated with SMI at P < 0.15 in univariate analysis (RR 3.95 [95% CI 2.21-7.06]; P < 0.0001). The association of osteoprotegerin with SMI was observed in male (P < 0.0001) and female (P = 0.03) patients, in type 1 (P = 0.002) and type 2 (P = 0.0004) diabetic patients, in patients with (P = 0.0004) or without (P = 0.03) nephropathy, and in patients without (P < 0.0001) but not with (P = 0.2) peripheral arterial disease.
CONCLUSIONS:Osteoprotegerin measurement, together with other conventional factors, can help to better define the diabetic population with an increased likelihood for SMI.

译文

目的: 我们试图评估骨保护素,一种参与动脉粥样硬化的破骨细胞生成抑制剂,以及其他新的危险因素作为无症状心肌缺血 (SMI) 的预测指标。
研究设计和方法: 使用负荷心肌灌注成像 (MPI) 评估了总共 465 名连续的糖尿病患者的 SMI,这些患者有不止一个额外的危险因素。我们研究了 SMI (正性应激心电图和/或异常 MPI) 与骨保护素、其他新的危险因素 (脂蛋白 [a] 、同型半胱氨酸、脂联素、 C 反应蛋白, 和纤维蛋白原),以及传统的危险因素 (总胆固醇、低密度脂蛋白、高密度脂蛋白胆固醇和甘油三酯)。
结果: 共有 92 例患者被诊断为 SMI。在六种新的标记物中,骨保护素是唯一一种与 SMI 相关的标记物; 相对风险 (RR) 骨保护素值高于 75 百分位的患者的 SMI 为 3.19 (95% CI 1.99-5.18; P <0.001),与骨保护素低于 75 百分位的患者相比。在单变量分析中,与 SMI 显著相关的其他血浆标志物是较高的甘油三酯 (P = 0.04) 和较低的高密度脂蛋白胆固醇 (P = 0.02)。在单变量分析中,骨保护素与 SMI 的关系在纠正了与 SMI 相关的其他变量后仍然显著,P <0.15 (RR 3.95 [95% CI 2.21-7.06]; P <0.0001)。在男性 (P <0.0001) 和女性 (P = 0.03) 、 1 型 (P = 0.002) 和 2 型 (P = 0.0004) 患者中观察到骨保护素与 SMI 的关联糖尿病患者,有 (P = 0.0004) 或无 (P = 0.03) 肾病的患者,在没有 (P <0.0001) 但没有 (P = 0.2) 外周动脉疾病的患者中。
结论: 骨保护素的测量,连同其他常规因素,可以帮助更好地定义糖尿病人群,增加 SMI 的可能性。

Silent myocardial ischemia

心血管 心肌缺血 疾病
概述  :  

心肌缺血是指心脏的血液灌注减少,导致心脏的供氧减少,心肌能量代谢不正常,不能支持心脏正常工作的一种病理状态。无症状性心肌缺血(SMI)又称无痛性或隐匿型冠状动脉粥样硬化性心脏病,是指患者无心绞痛或心肌缺血相关主观症状,而经检查发现有客观证据的一过性心肌缺血。可引起心肌代谢改变、心电活动异常和心肌收缩与舒张功能障碍。发生心肌缺血后为何无症状?要理解心肌缺血无症状的机制,首先要了解心肌缺血所引起的病生理变化。一般而言,心肌缺血的病生理改变有一定的规律:冠脉狭窄或闭塞→局部心肌缺血→舒张功能异常→

Silent [ˈsaɪlənt]

释义   n. (印、巴)茜郎特(人名)

adj. (silent) 沉默的;寂静的;无记载的

n. (silent) 无声电影

例句   But I decided that if I kept silent it would go on for years and no one would do anything about it.

但是我下了决心,如果我保持沉默的话,这样的事情将持续几年,没有人会做任何事。

 

Myocardial 英 [,maɪəʊ'kɑːdɪəl] 美 [,maɪə'kɑrdɪəl]

释义   adj. 心肌的

n. 心肌衰弱

例句   Objective To evaluate the value of echocardiography in the diagnosis of acute myocardial infarction and its complications.

目的评价超声心动图在急性心肌梗死及其并发症诊断中的应用价值。

 

Ischemia 英 [is'ki:miə] 美 [ɪs'kimɪə]

释义   n. [内科] 局部缺血

例句   It is very important that surgery is done on patients who have been properly evaluated, in terms of evaluating them for ischemia.

非常重要的一点是只有那些经过恰当评估,尤其是对缺血情况的评估的患者可以接受手术。


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