PEAR1、GSTP1基因型与脑梗死预后的相关性分析

Correlation Analysis of PEAR1,GSTP1 Genotype and Prognosis of Cerebral Infarction

目的 探讨PEAR1、GSTP1基因型与脑梗死预后的相关性,为脑梗死个体化精准治疗及二级预防提供理论参考.方法 选取首发症状型脑梗死患者,入院后遵循抑制血小板聚集、营养神经、改善循环及对症治疗原则,患者24 h内口服阿司匹林100 mg, 1次/d,并长期维持治疗.收集患者的一般资料、既往史、血小板相关指标、PEAR1及GSTP1基因型、相关待测量表评分及脑梗死复发周期,出院随访13个月.根据脑梗死复发及复发周期进行分组,比较PEAR1、GSTP1基因多态性及其他临床资料与脑梗死预后是否具有关联.结果 入组患者PEAR1基因突变型(AA+AG)占60.1%,未突变型(GG)占39.9%;GSTP1基因突变型(AG+GG)占31.8%,未突变型(AA)占68.2%.对比分析两组患者冠心病病史、出院时NIHSS评分、血小板计数及GSTP1基因型与脑梗死复发有关联.多因素Logistic回归分析显示冠心病病史、出院时低NIHSS评分、低血小板计数及GSTP1基因突变型(AG+GG)为脑梗死复发的独立危险因素(P<0.05).结论 首发症状型脑梗死患者年龄越大、出院时低NIHSS评分、低血小板计数或GSTP1为基因突变型(AG+GG)脑梗死预后较差.

Objective To investigate the correlation between PEAR1 and GSTP1 genotypes and prognosis of cerebral infarction,and to provide theoretical reference for individualized precise treatment and secondary prevention of cerebral infarction.Method The patients with first-episode symptomatic cerebral infarction were selected as the study subjects.After admission,the principles of inhibiting platelet aggregation,nourishing nerves,improving circulation and symptomatic treatment were followed,and long-term maintenance therapy of aspirin 100 mg oral once a day was implemented within 24 hours.General information,past history,platelet-related indicators,PEAR1 and GSTP1 genotypes,scores of relevant unmeasured scales,and recurrence period of cerebral infarction were collected.Patients were followed up for 13 months after discharge.Groups were divided according to the recurrence and recurrence cycle of cerebral infarction,and the relation of PEAR1,GSTP1 gene polym-orphism and other clinical data with the prognosis of cerebral infarction was compared.Results PEAR1 gene mutant(AA+AG)was 60.1%and 39.9%non-mutant(GG),respectively.GSTP1 gene mutant(AG+GG)was 31.8%and 68.2%non-mutant(AA),respectively.The history of coronary heart disease,NIHSS score at disch-arge,platelet count and GSTP1 genotype of the two groups were related with the recurrence of cerebral infarction.Multivariate Logistic regression analysis showed that history of coronary heart disease,low NIHSS score at discharge,low platelet count and GSTP1 gene mutation(AG+GG)were independent risk factors for recurrence of cerebral infarction(P<0.05).Conclusion Patients with first-symptom cerebral infarction with older age or coronary heart disease,low NIHSS score at discharge,low platelet count,or GSTP1 gene mutation(AG+GG)had worse prognosis.