PON1基因多态性与血小板再活化与支架内血栓的相关性研究

Correlation among PON1 gene polymorphism, platelet reactivation and in-stent thrombosis

目的探讨影响冠状动脉介入术(PCI)预后的危险因素,分析接受PCI患者血清对氧磷酯酶1(PON1)基因多态性、术后血小板再活化与PCI术后主要心血管事件和支架内血栓的相关性。方法筛选2015年1月~12月期间就诊雅安市人民医院PCI患者362例,检测PCI后测血小板聚集率(PAR),通过受试者工作曲线预测术后主要心血管事件(MACE)发生的最佳PAR值。将所有受试者分成术后血小板再活化(HPPR)组(PAR≥44.5%,即HPPR组)(n=180)和对照组(PAR<44.5%)(n=182),检测通过聚合酶链反应-限制性片段长度多态性技术实现,记录患者CYP2C19基因681(G/A)位点的基因型和等位基因,以及患者CYP2C19(681G/A)基因型、等位基因分布情况,统计分析住院期间与术后6个月患者MACE的发生情况。结果 HPPR组三个基因多态性位点(-108C/T,-126G/C及-162G/A)分别为63.9%、25.0%和23.9%显著高于对照组的25.6%、44.0%和12.1%,差异有统计学意义(P<0.05)。携带-108C/T基因型是PCI治疗后MACE和术后支架内血栓发生的独立预测因子,OR(95%CI)值为3.647(1.633~6.275),P=0.016。结论携带-108C/T基因型与HPPR是PCI治疗后MACE和支架内血栓发生的独立预测因子。

Objective To investigate the risk factors influencing the prognosis of percutaneous coronary intervention(PCI),and analyze the correlation among the gene polymorphism of serum paraoxonase(PON1),posttreatment platelet reactivation(HPPR),postoperative major adverse cardiovascular events(MACE)and in-stent thrombosis in patients undergone PCI.Methods The patients undergone PCI(n=362)were chosen from the People’s Hospital of Ya’an City from Jan.2015to Dec.2015.The platelet aggregation rate(PAR)was detected after PCI in all patients.The best PAR value of incidence of postoperative major adverse cardiovascular events(MACE)was predicted by using receiver operating curve(ROC).All patients were divided into HPPR group(PAR≥44.5%,n=180)and control group(PAR<44.5%,n=182)after PAR detection by using polymerase chain reactionrestriction fragment length polymorphism(PCR-RFLP).The genotypes and alleles of CYP2C19gene at681(G/A)loci and their distribution were recorded in each patient.The incidence of MACE was statistically analyzed in all patients during hospitalization and6months after PCI.Results The incidence of MACE and in-stent thrombosis was63.9%at-108C/T locus,25.0%at-126G/C locus and23.9%at-162G/A locus in HPPR group,which were all significantly higher than those in control group(25.6%,44.0%and12.1%,P<0.05).The genotype of-108C/T was an independent predictive factor for incidence of MACE and in-stent thrombosis(OR=3.647,95%CI:1.633-6.275,P=0.016).Conclusion The genotype of-108C/T and HPPR are independent predictive factors for incidence of MACE and in-stent thrombosis.