| Objective: The senile calcified valvular disease of the heart called again as the senile retrogression valvular disease of the heart is cardiac valve fibrous layer degenerative pathological changes cum calcium salts depositive consequence. That cardiac valves generate calcification both initiates valve malfunction and resultes in cardiac arrhythmia,chronic cardiac failure,myocardial infarction cerebrovascular disease and so on, sometime initiates cardiogenic sudden death. Pathogenesy of valvular calcification is not distinct yet, recently abroad many reports confirm that valvular calcification of the heart is a process of heterotopic calcification, and research discovery:there are associated proteins in cardiac valve. Therefore, calcification of cardiac valve and bone tissue is similar, this is an adjusting process of initiative. For this reason, it is very important to seek an index early predicting valvular calcification for treating and prognosis of the senile calcified valvular disease of the heart. Osteoprotegerin is one of superfamily member of tumor necrotic factor receptor, saying again as osteoclast genesis inhibitory factor. OPG is a kind of secreting type glycoprotein. Insulin-like growth factor-1 is a single strand polypeptide possessing endocrine,autocrine,paracrine character composite of seventy amino acid. OPG and IGF-1 all correlate close with bone metabolism, but correlated study of OPG,IGF-1 and calcification is very limited, especially there is short of correlated study with the senile calcific valvular disease of the heart. Serum OPG and IGF-1 samples in the senile calcific valvular disease of the heart were tested with a sensitive double-antibody enzyme-linked immunosorbent assay (ELISA) and analysis relation with clinical correlated index. This investigation will provide more insight in the pathogenesis of the early senile calcific valvular disease of the heart, and will provide new method for diagnosis and therapy.Methods: One hundred and sixteen senile patients above age seventy checked by ultrasonic cardiogram ,except rheumatic disease of the heart,congenital heart disease,infective endocarditis,protopathic parathyroid hormone accentuationhepatic dysfunction,renal inadequacy cum hematodialysis,malignant tumor,various kinds infection,wounds,bone metabolism affection,having taken decoagulant in recent six months(except antiplatelet aggregation). All patients were divided into four groups: aortic valve calcification, mitral valve calcification, allied valve calcification and normal control by ultrasonic cardiogram. All patients remained serum samples. All serum samples tested with a double-antibody enzyme-linked immunosorbent assay (ELISA) for each of OPG and IGF-1. Serum OPG and IGF-1 concentrations were compared among these four groups. Patients were assessed according to a standard protocol, which included gender,age,weight,high blood pressure,diabetes,coronary heart disease and smoking history and so on. Blood was taken for determination of Ca,P,ALP,FBG,TC,TG,LDL and HDL. Correlation coefficients and significant were calculated between OPG (or IGF-1) and clinical correlated indexes.SAS 6.12 was used to process all datas. Quantitative data were expressed as ((x|-)±s). P values of <0.05 were considered significant.Results: 1 Results detected by ultrasonic cardiogramIn the group of 116 in the senile calcific valvular disease patients of the heart, with a mean age of (78.3±5.5) yr, 61 were male, 55 were female, and they were all detected by ultrasonic cardiogram. There were 36 people with a mean age of (83.4±5.8) yr in simple aortic valve calcification group (AVC). In the group of AVC, 20 were male, 16 were female; There were 24 people with a mean age of (82.6±5.9) yr in simple mitral valve calcification group (MVC). In the group of MVC, 10 were male, 14 were female; There were 30 with a mean age of (83.0±6.3) yr in allied valve calcification group (AVC+MVC). In the group of (AVC+MVC), 17 were male, 13 were female; There were 26 with a mean age of (73.1±3.6) yr in normal control (NC). In the group of NC, 14 were male, 12 were female.2 Serum OPG and IGF-1 concentrations2.1 Serum OPG concentrations: Serum OPG concentrations in the group of AVC,MVC and AVC+MVC respectively 481.34±362.36pg/ml,469.45±303.94pg/ml,431.64±297.34 pg/ml were all significantly higher than the concentrations of NC 138.22±122.48pg/ml (F=3.25, p<0.05). Compared between two random calcification groups, no significant differences were seen (p>0.05, all).2.2 Serum IFG-1 concentrations: Serum IFG-1concentrations in the group of AVC,MVC and AVC+MVC respectively 281.72±71.35pg/ml,261.46±64.74pg/ml,267.84±65.13pg/ml were significantly higher than the concentrations of NC 137.20±43.20pg/ml (F=11.36, p<0.05). Compared between two random calcification groups, no significant differences were seen (p>0.05, all).3 Determination of clinical correlated indexes3.1 compared age and rate of high blood pressure,diabetes,coronary heart disease and smoking from different groupsSerum age concentrations: Serum age concentrations in the group of AVC,MVC and AVC+MVC respectively 83.36±5.82 yr,82.63±5.92yr,83.00±6.33yr were significantly higher than the concentrations of NC 73.10±3.60yr (F=8.70,p<0.001). Compared between two random calcification groups, no significant differences were seen (p>0.05, all).There were 36 people in the group of AVC, 24 people in the group of MVC, 30 people in the group of (AVC+MVC) and 26 people in the group of NC. The number and rate of high blood pressure,diabetes,coronary artery disease and smoking patients in the group of AVC,MVC and AVC+MVC were respectively 27(75.0%),14(58.3%),17(56.7%);20(55.6%),13(54.2%),14(46.7%) ;28(77.8%),19(79.2%),20(66.7%);26(72.2%),13(54.2%),15(50.0%) were significantly higher than the number and rate of NC 6(23.1%),3(11.5%),8(30.8%),5(19.2%) respectively, x2 (8.328,7.976,8.622,8.058 respectively, p<0.05 all). Compared between two random calcification groups in the same one index, no significant differences were seen (p>0.05, all).3.2 Determination of clinical correlated indexesSerum Ca,P and HDL concentrations in the group of AVC,MVC,AVC+MVC and NC (Serum Ca 2.20±0.11mmol/L,2.18±0.10mmol/L,2.19±0.10mmol/L,2.18±0.09mmol/L, respectively;Serum P 1.20±0.19mmol/L,1.17±0.19mmol/L,1.19±0.22mmol/L,1.09±0.18mmol/L, respectively) ; Serum HDL 1.05±0.35mmol/L,1.00±0.30mmol/L,1.01±0.30mmol/L,0.97±0.19mmol/L, respectively) were all no significant differences (F=0.07,0.26,0.19 respectively,p>0.05).Serum ALP,FBG,TC,TG and LDL concentrations in the group of AVC,MVC,AVC+MVC (Serum ALP 60.36±12.46 IU/L,60.75±11.91IU/L,64.89±15.02IU/L respectively;Serum FBG 3.64±0.26g/L,3.56±0.26g/L,3.54±0.25g/L, respectively;Serum TC 4.35±0.67mmol/L,4.77±0.94mmol/L,4.93±0.97 mmol/L, respectively;Serum TG 1.55±0.73mmol/L,1.39±0.78 mmol/L,1.48±0.76mmol/L, respectively;Serum LDL 2.79± 0.53mmol/L,2.44±0.58 mmol/L,2.68±0.60mmol/L, respectively) were all significantly higher than the concentrations of NC 37.20±10.25 IU/L,3.18±0.32g/L,3.07±0.80mmol/L,0.77±0.57mmol/L,1.56±0.61mmol/L, respectively;F(12.01,4.68,13.47,2.95,12.18 respectively, p<0.05, all). Compared between two random calcification groups in the same one index, no significant differences were all seen (p>0.05).4 Correlated analysis:4.1 Serum concentrations of OPG correlated negatively significantly with serum concentrations of TC and TG (r=-0.413,-0.446, respectively, P<0.05, all); There were no significantly correlations between serum concentrations of OPG and serum LDL,HDL,weight(r=-0.086,-0.094,-0.115, respectively, P>0.05, all); Serum concentrations of OPG correlated positively significantly with age (r=0.5812, P<0.05).4.2 Serum concentrations of IGF-1 correlated negatively significantly with serum concentrations of TC,TG and LDL (r=-0.573,-0.651,-0.487, respectively, P<0.05 all); There were no significantly correlations between serum concentrations of OPG and serum HDL,weight (r=0.077,0.069, respectively, P>0.05, all); Serum concentrations of OPG correlated positively significantly with age (r=0.572, P<0.05).Conclusion: 1 Serum OPG and IGF-1 concentrations increased significantly in this study, it suggests that OPG and IGF-1 are thought to play an important role in senile calcified valvular disease of the heart (SCVDH).2 Serum concentrations of OPG and IGF-1 in SCVDH correlated negatively significantly with TC, TG; Serum concentrations of OPG and IGF-1 correlated positively significantly with age.3 Serum OPG and IGF-1 determination is useful for early diagnosis of SCVDH, evaluation of SCVDH activity and prediction of the prognosis of valve function. If serum OPG and IGF-1 concentrations increased significantly, we should notice valve calcification; Intercepting of serum highlevel OPG and IGF-1 expression may be an effective therapeutic approach for patients with early SCVDH.
|
PDF Full Text Request