CHD患者PCI术后氯吡格雷治疗与出血事件发生和TIAM2基因突变的关系及其影响因素

Relationship between clopidogrel therapy with bleeding events and TIAMI2 gene mutation in patients with CHD after PCI and its influencing factors

目的探讨冠状动脉性心脏病(CHD)患者经皮冠状动脉介入术(PCI)后应用氯吡格雷治疗发生出血事件与T细胞淋巴瘤侵袭转移因子2(TIAM2)基因突变的关系及影响出血事件的相关因素。方法选取该院心血管内科行急诊PCI后采用氯吡格雷治疗的200例CHD患者,进行随访观察半年,7例患者失访,根据是否发生出血事件分为出血组33例,未出血组160例,采用聚合酶链反应(PCR)测定TIAM2基因型,分析TIAM2基因型与出血事件的关系,并分析出血事件的相关因素。结果PCR法测得TIAM2基因出现3个位点有等位基因出现突变,分别为:3168+3261A>G、3168+3116C>T、3168+3596A>C,分别统计分析这3个位点等位基因各种基因构成在出血组和未出血组间的差异,结果差异均无统计学意义(P>0.05)。Logistic回归模型进行分析:消化道溃疡病史(OR=2.096),入院前诊断为急性冠脉综合征(ACS)的(OR=1.842),应用血小板糖蛋白(GP)Ⅱb/Ⅲa拮抗剂(OR=1.692)是CHD患者PCI后应用氯吡格雷治疗发生出血事件的危险因素(P<0.05)。结论 CHD患者PCI后应用氯吡格雷治疗发生出血事件与消化道溃疡病史,入院前诊断为ACS,应用GPⅡb/Ⅲa拮抗剂有关,与TIAM2基因突变无关。

Objective To study the relationship between bleeding events occurrence due to clopidogrel use and TIAM2 gene mutation in the patients with coronary heart disease（CHD） after percutaneous coronary intervention （PCI） and the related factors influencing bleeding events. Methods Two＇hundreds cases of CHD treated by clopidogrel after emergency PCI were selected and followed for six months. Seven cases were lost to follow-up. According to whether the bleeding event happened or not, the patients were divided into the bleeding group（33 cases） and non-bleeding group（160 cases）. TIAM2 genotypes were detected by polymerase chain reaction （PCR） assay. The relationship of TIAM2 genotype with bleeding events and related factors of bleeding events were analyzed. Results The PC R method measured the TIAM2 gene appearing 3 loci with mutation,which were 3168＋ 326tAnG, 3168＋3116C〉T and 3168＋3596A〉C respectively, the gene constitute of these 3 loci had no statistical difference between the bleeding group and non-bleeding group （P 〉 0.05）. In the Logistic regression analysis, the history of peptic ulcer disease （OR = 2. 096） ,diagnosis of acute coronary syndrome （ACS） before admission（OR= 1. 842） ,application of platelet glycoprotein （GP） Ⅱ b/ a antagonist（OR= 1. 692） were the risk factors of bleeding events occurrence during using clopidogrel in CHD patients after PCI （P〈0.05）. Conclusion The bleeding events occurrence during hsing clopidogrel in CHD patients after PCI is related with the his- tory of peptic ulcer disease,diagnosis of ACS before admission and application of GP Ⅱ a Ⅲb/antagonists,and has no relation with TIAM2 gene mutation.