肿瘤坏死因子-α G308A单核苷酸多态性与心脏瓣膜置换术后并发症发生的相关性研究

Tumor necrosis factor-αassociation between 308 GA single nucleotide polymorphism and complications after cardiac valve replacement

目的探讨肿瘤坏死因子-α(TNF-α)G-308A单核苷酸多态性与心脏瓣膜置换术后并发症发生的相关性。方法收集2018年1月到2020年1月阜外华中心血管病医院收治的173例瓣膜置换术患者临床资料,根据是否出现并发症分为并发症组和非并发症组,采用Taqman基因分型技术对TNF-α多态性位点308A/G进行基因分型;分析两组患者TNF-α 308核苷酸基因型。分析不同并发症(脑血管意外、肺部感染、低心排出量、肾功能不全和死亡) TNF-α 308核苷酸基因型;采用多因素Logistic回归分析筛选影响瓣膜置换术后并发症的独立危险因素。结果无并发症患者GG基因型频率(80.54%,120/149)明显高于有并发症患者GG基因型频率(54.17%,13/24),差异有统计学意义(χ^(2)=7.109,P<0.05)。无并发症患者GA基因型频率(13.42%,20/149)明显低于有并发症患者GA基因型频率(29.17%,7/24),差异有统计学意义(χ^(2)=6.001,P<0.05)。无并发症患者AA基因型频率(6.06%,9/149)明显低于有并发症患者AA基因型频率(16.67%,4/24),差异有统计学意义(χ^(2)=4.917,P<0.05)。无并发症患者G等位基因频率(87.25%,130/149)明显高于有并发症患者G基因型频率(68.75%,17/24),差异有统计学意义(χ^(2)=6.987,P<0.05)。无并发症患者G等位基因频率(12.75%)明显低于有并发症患者A基因型频率(31.25%),差异有统计学意义(χ^(2)=6.153,P<0.05)。无并发症患者外周血TNF-α水平[(1.23±0.27) ng/ml]明显低于有并发症患者外周血TNF-α水平[(1.85±0.35) ng/ml],差异有统计学意义(t=4.991,P<0.05)。GG基因型患者外周血TNF-α水平[(1.03±0.23) ng/ml]明显低于GA基因型患者外周血TNF-α水平[(1.45±0.28) ng/ml],差异有统计学意义(t=3.019,P<0.05)。GA基因型患者外周血TNF-α水平[(1.98±0.31) ng/ml]明显低于AA基因型患者外周血TNF-α水平[(1.45±0.28) ng/ml],差异有统计学意义(t=4.018,P<0.05)。多因素Logistic回归分析结果显示TNF-α G308A是瓣膜置换术后发生并发症的独立因素。结论 TNF-α G308A是瓣膜置换术后发生并发症的独立因素。

Objective To investigate the relationship between tumor necrosis factor-α(TNF-α)G308A single nucleotide polymorphism and complications after heart valve replacement.Methods The clinical data of 173 patients with valve replacement in our hospital from January 2018 to January 2020 were collected,and they were divided into complication group and non-complication group according to whether there were complications.Genotyping technique was used to detect TNF-α(TNF-α)polymorphism 308 G/A was genotyped.The genotypes of TNF-α308 were analyzed.The genotypes of TNF-α308 in different complications were analyzed;Multivariate logistic regression analysis was used to screen the independent risk factors of postoperative complications.Results The frequency of GG genotype in patients without complications(80.54%,120/149)was significantly higher than that in patients with complications(54.17%,13/24,χ^(2)=7.109,P<0.05).The frequency of GA genotype in patients without complications(13.42%,20/149)was significantly lower than that in patients with complications(29.17%,7/24,χ^(2)=6.001,P<0.05).The frequency of AA genotype in patients without complications(6.06%,9/149)was significantly lower than that in patients with complications(16.67%,4/24,χ^(2)=4.917,P<0.05).The frequency of G allele in patients without complications(87.25%,130/149)was significantly higher than that in patients with complications(68.75%,17/24,χ^(2)=6.987,P<0.05).The frequency of G allele in patients without complications(12.75%)was significantly lower than that of a genotype in patients with complications(31.25%,χ^(2)=6.153,P<0.05).The level of TNF-αin peripheral blood of the patients without complications[(1.23±0.27)ng/ml]was significantly lower than that of patients with complications[(1.85±0.35)ng/ml,t=4.991,P<0.05].The level of TNF-αin peripheral blood of patients with GG genotype[(1.03±0.23)ng/ml]was significantly lower than that of patients with GA genotype patients[(1.45±0.28)ng/ml,t=3.019,P<0.05].The level of TNF-αin peripheral blood of patients with GA genotype[(1.98±0.31)ng/ml]was significantly higher than that of AA genotype patients[(1.45±0.28)ng/ml,t=4.018,P<0.05].Multivariate logistic regression analysis showed that TNF-αand G308A were independent factors of postoperative complications.Conclusion TNF-αand G308A are independent factors of complications after valve replacement.