炎症相关基因多态性与心脏瓣膜置换术后华法林疗效的相关性研究

Association of inflammation-associated gene polymorphism with Warfarin therapy after cardiac valve replacement

目的 探讨炎性基因IL-17的多态现象与心脏瓣膜置换术后华法林疗效的关系.方法 纳入我院行心脏瓣膜置换术采用华法林治疗的患者96例作为观察组,另外纳入未采用华法林治疗的生物瓣置换术患者78例作为对照组.采用基因测序的方法确定单核苷酸多态性的等位基因,分析两组患者的基因型及临床特点,探讨分析心脏瓣膜置换术后华法林治疗与不同的IL-17基因型之间的关系;采用Logistic回归分析基因型与心脏瓣膜置换术后危险因素之间的相关性;运用Kaplan-Meier的生存曲线对携带IL-17rs763780及rs2275913两种基因型患者的生存及疗效情况进行分析.结果 IL-17基因型在两组的基因型分布是不相同的.通过多因素的Logistic回归分析显示,rs763780（OR =2.998,95％CI 1.176～7.639,P=0.023）及rs2275913 （OR=2.936,95％CI 1.198～7.246,P=-0.019）两种基因型是心脏瓣膜置换术后并发症发生的危险因素;术后携带rs763780基因型者心脏瓣膜置换术后严重并发症发生的风险增加16％,而携带rs2275913基因型者心脏瓣膜置换术后严重并发症发生的风险增加28％.疗效及生存分析方面,携带rs2275913基因型IL-17高表达的患者生存时间为（37.34±10.90）个月,而低表达的患者生存时间为（54.23±12.43）个月,两组比较差异具有统计学意义,IL-17rs2275913基因型表达的高低与预后有着一定的相关性.结论 IL-17的G等位基因是心脏瓣膜置换术后并发症发生的危险因素;rs2275913基因型与心脏瓣膜置换治疗及预后有着相关性,可作为心脏瓣膜置换术后严重并发症发生的危险因素.

Objective To elucidate the relationship between polymorphism of inflammatory gene IL-17 and Warfarin therapy after heart valve replacement.Methods A total of 96 patients were enrolled in this study,and 78 patients who underwent heart valve replacement without warfarin were included in the study.Genomic sequencing.Ninety-six patients who underwent cardiac valve replacement were treated with warfarin as the observation group,and 78 patients who were not treated with warfarin were included as control group.Gene sequencing method was used to determine the content of single nucleoside The polymorphisms of IL-17 and IL-17 were analyzed by using logistic regression analysis.Results The genotype distribution of IL-17 genotype in two groups was different.Logistic regression analysis showed that rs763780 （OR =2.998,95%CI 1.176-7.639,P=0.023） and rs2275913 （OR=2.936,95%CI 1.198-7.246,P=0.019） were the risk factors for postoperative complications of heart valve replacement.Patients with rs763780 genotype had an increased risk of serious complications after cardiac valve replacement.While those with rs2275913 genotype had a 28% greater risk of serious complications after heart valve replacement （37.34±10.90） months in the patients with high expression of rs2275913 genotype IL-17 and （54.23±12.43）months in the patients with low expression（P〈0.05）.There were significant differences between the two groups in the survival and survival time The expression of IL-17 rs2275913 genotype had a certain correlation with the prognosis.Conclusion Gallele of IL-17 is a risk factor for postoperative complications of heart valve replacement.The rs2275913 genotype is associated with heart valve replacement and prognosis,and may be a risk factor for heart valve replacement.