儿茶酚胺氧位甲基转移酶基因多态性与动脉瘤性蛛网膜下隙出血后早期脑血管痉挛的相关性

Correlation between COMTgene polymorphism and early cerebral vasospasm after aneurismal subarachnoid hemorrhage

目的探讨儿茶酚胺氧位甲基转移酶（catechol-O-methyltransferase,COMT）基因多态性与动脉瘤性蛛网膜下隙出血（subarachnoid hemorrhage,SAH）后早期脑血管痉挛（cerebral vasospasm,CVS）的相关性。方法搜集重庆医科大学附属第一医院神经外科2008年1月至2008年12月收治的167例自发性SAH急性期（〈3d）患者的临床资料。运用聚合酶链反应-限制性片段长度多态性（PCR-RFLP）技术分析SAH患者COMT基因型及等位基因频率;运用TCD判定SAH患者早期CVS的严重程度;运用Hunt-Hess分级评估患者病情严重程度;运用头颅CT的Fisher分级评估出血量的多少。采用χ2检验和logistic回归分析等方法分析COMT基因分型结果等临床资料与CVS的相关性。结果各等位基因分布符合Hardy-Weinberg定律,研究样本为遗传平衡群体。A等位基因携带者的CVS发生率（51.7%）明显高于G等位基因携带者（38.5%）。A/A基因型患者CVS发生率（66.7%）明显高于G/G（35.9%）。单因素logistic回归分析提示A等位基因、A/A基因型和Hunt-Hess分级3~5级与CVS具有相关性。调整临床相关因素后,多因素logistic回归仍提示A等位基因、A/A基因型是SAH后早期CVS的危险因素。结论 COMTA等位基因、A/A基因型可能是SAH后早期CVS的危险因素。

Objective To analyze the correlation between catechol-O-methyltransferase（COMT）gene polymorphism and cerebral vasospasm（CVS）in early period after subarachnoid hemorrhage（SAH）.Methods The clinical data of 167 patients with spontaneous SAH,who were treated in our hospital from Jan.2008 to Dec.2008,were collected for this study.COMT genotyping was performed by means of polymerase chain reaction-restriction fragment length polymorphism（PCR-RFLP）.The degree of CVS was identified by transcranial Doppler（TCD）.Hunt-Hess classification was used to evaluate the severity of the patients＇ condition.The bleeding amount was evaluated by means of Fisher classification of head CT.χ2 test（SPSS13.0 software）and logistic regression were adopted to analyze the correlation of COMTgene polymorphism and other clinical data with early CVS after SAH.Results The distribution of each allele matched with Hardy-Weinberg law and the research samples were heredity equilibrium population.Early CVS incidence of patients with COMT A allele was significantly higher than those with COMTG allele（51.7% vs 38.5%,P〈0.01）.Early CVS incidence of patients with COMT A/A genotype was significantly higher than those with COMT G/G genotype（66.7% vs 35.9%,P〈0.05）.Univariate logistic regression demonstrated that COMT A allele,A/A genotype and Grade 3-5 of Hunt-Hess classification were all associated with early CVS.After adjustment of general information,further multivariate logistic regression demonstrated that COMTA allele,A/A genotype were the risk factors of early CVS after SAH.Conclusion COMTA allele and A/A genotype might be risk factors of early CVS after SAH.