PAI-1基因多态性与缺血性脑卒中rt-PA静脉溶栓后出血性转化和血管再闭塞的相关性

Relationship between PAI-1 Gene Polymorphism and Hemorrhagic Transformation and Vascular Reocclusion after Intravenous Thrombolysis with rt-PA in Ischemic Stroke

目的 探讨纤溶酶原激活物抑制因子1(PAI-1)基因多态性与缺血性脑卒中rt-PA静脉溶栓后出血性转化和血管再闭塞的相关性。方法 将蚌埠市第三人民医院收治的232例接受rt-PA静脉溶栓治疗的急性缺血性脑卒中患者作为研究对象,根据患者是否出现血管再闭塞或出血性转化(HT),分为再闭塞率组(41例),HT组(36例)和对照组(155例)。比较2组患者血清PAI-1水平和PAI-1基因675位点多态性,并对不同基因型患者血清PAI-1水平进行分析。结果 再闭塞组患者血清PAI-I水平明显高于对照组,而HT组患者血清PAI-I水平明显低于对照组,差异具有统计学意义(P<0.05)。基因型分析结果表明,再闭塞组4G/4G型患者比例明显高于对照组,而HT组患者4G/4G型患者比例明显低于对照组,差异具有统计学意义(P<0.05)。结论 急性缺血性脑卒中患者接受rt-PA治疗溶栓治疗后发生血管再闭塞或HT与血清PAI-1水平密切相关,而PAI-1基因675位点4G/4G是影响PAI-1水平重要因素,可能是导致患者对rt-PA溶栓治疗后出现治疗效果差异的主要原因。

Objective To investigate the relationship between PAI-1 gene polymorphism and cerebral venous thrombolysis occlusion.Methods A total of 232 patients with acute ischemic stroke who received RT PA intravenous thrombolysis in our hospital were selected as the research objects.According to whether the patients had reocclusion or hemorrhagic transformation (HT),they were divided into reocclusion rate group (41 cases),HT group (36 cases) and control group (155 cases).The serum PAI-1 level and PAI-1 gene 675 polymorphism were compared between the two groups,and the serum PAI-1 levels of patients with different genotypes were analyzed.Results The serum PAI-I level in the reoxygenation group was significantly higher than that in the control group,while the serum PAI-I level in HT group was significantly lower than that in the control group (P<0.05).Genotype analysis showed that the proportion of patients with 4G/4G genotype in the reocclusion group was significantly higher than that in the control group,while the proportion of patients with 4G/4G in HT group was significantly lower than that in the control group,the difference was statistically significant (P<0.05).Conclusion The level of PAI-1 in patients with acute ischemic stroke after thrombolytic therapy with RT PA is closely related to the level of serum PAI-1,and 4G / 4G at 675 site of PAI-1 gene is an important factor affecting the level of PAI-1,which may be the main reason for the difference of therapeutic effect after thrombolytic therapy with rt-PA.