环氧化酶基因多态性的相互作用与缺血性脑卒中患者阿司匹林抵抗的关系

The relationship between interaction of cyclooxygenase gene polymorphism and aspirin resistance in patients with ischemic stroke

目的探讨环氧化酶(cyclooxygenase,COX)基因多态性的相互作用与缺血性脑卒中患者阿司匹林抵抗的关系,为缺血性脑卒中的防治提供参考。方法收集2015-06~2016-05住院治疗的首次发病的缺血性脑卒中患者719例,均给予阿司匹林治疗,采用光学比浊法检测血小板聚集率,收集患者的临床资料,用PCR法测定COX-1、COX-2基因多态性,对存在阿司匹林抵抗与对阿司匹林敏感患者的临床资料进行单因素分析,并分析COX-1、COX-2基因多态性及其相互作用与阿司匹林抵抗的关系。结果阿司匹林抵抗组176例,阿司匹林敏感组543例。阿司匹林抵抗组患者女性比例、糖尿病比例、低密度脂蛋白、空腹血糖明显高于阿司匹林敏感组(P<0.05)。两组患者在COX-1、COX-2基因各位点基因型分布方面比较差异无统计学意义(P>0.05)。糖尿病和rs3842787、rs20417相互作用是阿司匹林抵抗的危险因素(P<0.05)。结论 COX两个或多个位点基因相互作用可能会增加阿司匹林抵抗的风险。

Objective To investigate the relationship between interaction of cyclooxygenase（ COX） gene polymorphism and aspirin resistance in patients with ischemic stroke. Methods 719 patients with the first onset of ischemic stroke were treated in our hospital from June 2015 to May 2016,and they were treated with aspirin. The platelet aggregation rate was determinated by optical turbidimetry. The clinical data were collected,and the COX-1,COX-2 gene polymorphisms were determinated. The clinical data of the patients with aspirin resistance or aspirin sensitive were studied by means of single factor analysis,and the relationship between COX-1,COX-2 gene polymorphisms,their interaction and aspirin resistance was analyzed. Results 176 cases were included in the aspirin resistance group and 543 cases in the aspirin sensitive group. The proportion of women,diabetes,the levels of low density lipoprotein and fasting blood glucose in the aspirin resistance group were significantly higher than those in the aspirin sensitive group（ P〈0. 05）. There were no significant differences in the genotype distributions of COX-1 and COX-2between the two groups（ P〉0. 05）. Diabetes,interactions between rs3842787 and rs20417 were the risk factors of aspirin resistance（ P〈0. 05）. Conclusion The interactions of COX between two or among three multi-locus genotypes or more may increase the risk of aspirin resistance.