血管紧张素系统基因多态性与经皮冠状动脉腔内成形术加支架置入术后支架内再狭窄的关系

Gene polymorphism of rennin-angiotensin system and in-stent restenosis after percutaneous transluminal coronary angioplasty plus stenting

目的:心血管支架内再狭窄的好发因素很多,在探讨肾素-血管紧张素系统基因型与冠状动脉粥样硬化性心脏病患者经皮冠状动脉腔内成形术及支架置入术后支架内再狭窄相关性的基础上,进一步分析支架内再狭窄发生的其他相关因素。方法:选择2003-03/2004-12于复旦大学附属中山医院心血管内科接受经皮冠状动脉腔内成形术加支架置入术的上海籍汉族患者103例,有6个月随访造影资料并且临床资料完整,均知情同意。根据临床诊断标准,将患者分为再狭窄组(n=30)和未狭窄组(n=73)。再狭窄组30例,根据病例情况调查表,对患者的年龄、病史、实验室检查结果、狭窄病情、经皮冠状动脉腔内成形术和支架相关因素等进行综合分析,对患者冠状动脉狭窄情况、血管紧张素Ⅰ转换酶、血管紧张素原(M235T)和血管紧张素Ⅱ受体1(A1166C)基因型与支架内再狭窄的关系进行多元Logistic回归分析。结果:①103例患者全部进入结果分析,经皮冠状动脉腔内成形术加支架置入术后支架内再狭窄发生率为29.19%。②再狭窄组患者多支狭窄发生率大于未狭窄组(χ2=14.203,P=0.000)。③血压、血脂、支架个数、安放次数、安放位置等因素、支架置入前经皮冠状动脉腔内成形术的次数、扩张程度、是否更换球囊或更换球囊种类与术后是否发生支架内再狭窄无关(P>0.05)。④血管紧张素Ⅰ转换酶(D/I)与支架内再狭窄具有相关性(P<0.05)。结论:经皮冠状动脉腔内成形术加支架置入术患者的血管紧张素Ⅰ转换酶(D/I)基因型和冠状动脉多支狭窄与支架内再狭窄存在关联。

AIM： Many factors can result in in-stent restenosis （ISR） following cardiovascular disease. This article is aimed to make further investigation on the correlation between the incidental factors and ISR in patients with coronary atherosclerotic heart disease （CAHD） on the basis of the association between the genetic polymorphism of rennin-angiotensin system （RAS） related gene and ISR after percutaneous trensluminal coronary angioplasty （PTCA） and stenting. METHODS： 103 patients of Han nationality undergoing PTCA in Shanghai Chinese population were enrolled at Department of Cardiovascular Disease of Zhongshan Hospital of Fudan University from March 2003 to December 2004. They were divided into two groups according to ctinical diagnosis standard： ISR group （n =30） and non-ISR group （n = 73）. Comprehensive analysis was carded out on the patients＇ age, history, experimental test, ISR condition, and PTCT related factors according to the investigation on the patients. Multiple Logistic regression analysis was performed in coronary stenosis, angiotensin Ⅰ converting enzyme （ACE） （D/I）, angiotensinogen （M235T） and angiotensin receptor 1 （A1166C） genetype and relationship with ISR. RESULTS： （1）Totalty 103 patients were involved in the result analysis. The incidence of ISR after PTCA in the patients was 29.19%. （2）The incidence of ISR was higher in the ISR group than the non-ISR group （X^=14.203,P=0.000）. Blood pressure, blood lipid, number of stent, frequency of implant, place of implant, frequency of PTCA before implantation, degree of expansion, change of sacculus proprius and type of sacculus proprius were not correlated with ISR （P〉 0.05）. （4）There might be correlation between ACE （D/I） and ISR （P〈 0.05）. CONCLUSION： ACE genetype and stenosis in multiple coronary arteries are closely related with incidence of ISR after PTCA and stenting.