血小板糖蛋白Ⅲa基因多态性与颅内外动脉支架置入术后服用阿司匹林患者血管事件风险的相关性：前瞻性病例系列研究

Correlation between platelet glycoprotein Ⅲ a gene polymorphism and the risk of vascular events in patients taking aspirin after intracranial and extracranial artery stenting： a prospective case series study

目的探讨血小板糖蛋白（phtelel glycoprotein，GP）Ⅲa基因rs5918、rs2317676和rs11871251多态性与颅内外动脉支架置人术后长期服用阿司匹林患者血管事件发生的相关性。方法前瞻性连续纳入2009年12月至2012年10月期间成功施行脑血管支架置入术的患者。应用多重连接酶检测反应技术分析GPⅢa基因多态性。对患者进行临床随访，主要终点事件为缺血性卒中、血管性死亡和心肌梗死。结果共纳入433例基因分型成功并获得随访信息的患者。对患者进行平均（10．21±2．71）个月的随访，28例患者发生血管事件。基因分型表明，rs5918、rs2317676和rs11871251最小等位基因频率分别为0．46％、20．67％和48．73％。临床随访表明，rs1l871251A等位基因携带者主要终点事件发生率显著性高于非携带者[风险比（hazard ratio，HR）8．83，95％可信区间（confidence interval，CI）1．20～65．00；P=0．032]；对rs5918和rs2317676不同基因型进行的比较显示，终点事件发生率均无统计学差异（Log rank P分别为0．608和0．556）。多因素Cox风险比例模型分析显示，携带rs1l871251A等位基因是终点事件发生的独立危险因素（HR7．878，95％C／1．035～59．982；P=0．046），吸烟是转归不良的独立保护因素（HR0．327，95％CI 0．108～0．990；P=0．048）。结论GPⅢa基因rs11871251位点多态性可能是影响颅内外动脉支架置入术后服用阿司匹林患者血管事件发生的危险因素。

Objective To investigate the correlation between platelet glycoprotein （GP） III a polymorphisms of rs5918, rs2317676, and rs11871251 and the occurrence of vascular events in patients long-term taking aspirin after intracranial and extracranial artery stenting. Methods The patients who successfully performed cerebral vascular stenting from December 2009 to October 2012 were enrolled respectively. The GP II a polymorphisms were analyzed by using multiple ligase detection reaction. The clinical follow-up was conducted for the patients. The primary endpoint events were ischemic stroke, vascular death, and myocardial infarction. Results A total of 433 patients whose genotyping success and the follow-up information available were enrolled. They were followed up for mean 10. 21 ±2.71 months, and 28 patients had vascular events. Genotyping showed that the minor allele frequencies （MAF） of rs5918, rs2317676, and rs11871251 were 0. 46%, 20. 67%, and 48.73%, respectively. The clinical follow-up showed that the incidence of the primary endpoint events of the carriers of rs11871251 A allele was significantly higher than that of the noncarriers （hazard ratio [ HR], 8.83, 95% confidence interval [ CI] 1.20 -65.00; P =0. 032）. Comparison of different genotypes of rs5918 and rs2317676 showed that there was no significant difference in the incidence of endpoint events （Log rank, P = 0. 608 and 0. 556, respectively）. Multivariate Cox proportional hazards model analysis showed that the rs11871251 A allele was the independent risk factor for the occurrence of endpoint events （HR 7. 878, 95% HR 1. 035 - 59. 982; P=0. 046）, and smoking was an independent protective factor for poor outcome （HR O. 327, 95% CI 0. 108 -0. 990; P = 0. 048）. Conclusions GP III a gene rs11871251 polymorphism may be a risk factor affecting patients taking aspirin after intracranial and extracranial artery stenting.