β_(1)-肾上腺素能受体基因多态性对STEMI患者室性心律失常和短期预后的影响

Impact ofβ_(1)-adrenergic receptor gene polymorphism on ventricular arrhythmias and short-term prognosis in STEMI patients

目的:分析β_(1)-肾上腺素能受体基因多态性对急性ST段抬高型心肌梗死(STEMI)患者室性心律失常以及6个月预后的影响。方法:采用回顾性队列研究方式,按照纳入与排除标准选择云浮市人民医院2021年1月至2023年2月间收治的STEMI患者为研究对象,采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)分析患者β_(1)-肾上腺素能受体Arg389Gly基因型多态性,并根据β_(1)-肾上腺素能受体Arg389Gly基因型多态性类别分为CC组(Arg389Arg,87例)、CG组(Arg389Gly,73例)和GG组(Gly389Gly,18例)三组。对比三组患者收集的入院临床资料[包括Killip分级、心率、收缩压、舒张压、左心室射血分数(LVEF)、左心室舒张末径(LVDD),以及血清肿瘤坏死因子α(TNF-α)、N末端B型利钠肽前体(NT-proBNP)、肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs-CRP)等]和出院后通过门诊或电话对其进行6个月随访的结果(包括心率、NT-proBNP、CK-MB、LVEF、LVDD及主要心脏不良事件)的差异。结果:研究共纳入178例STEMI合并室性心律失常的患者,其中CC组有87例(48.9%),CG组有73例(41.0%),GG组有18例(10.1%);三组患者的年龄、性别、体重、BMI、吸烟史、饮酒史、合并疾病、收缩压、舒张压、心率、Killip分级(Ⅲ和Ⅳ级)以及血清TNF-α、NT-proBNP、CK-MB、hs-CRP及LVEF和LVDD均没有显著差异(P>0.05);随访6个月GG组和CG组心功能各项指标结果均显著优于CC组(P<0.05),而GG组的NT-proBNP和CK-MB结果显著低于CG组(P<0.05);统计三组患者随访期间主要心脏不良事件的发生情况,显示CC组的总发生数为17例(19.5%),CG组的总发生数为5例(6.9%),GG组的总发生数为1例(5.6%),组间差异显著(χ^(2)=6.887,P<0.05)。结论:β_(1)-肾上腺素能受体Arg389Gly基因多态性与STEMI合并室性心律失常患者的病情严重程度无关,但与治疗后心功能改善情况以及短期预后有关。

AIM:To examine how the variation of theβ_(1)-adrenergic receptor gene affects the occurrence of ventricular arrhythmias and the prognosis over a 6-month period in individuals suffering from acute ST-segment elevation myocardial infarction(STEMI).METHODS:A study was conducted retrospectively,where patients diagnosed STEMI and treated at Yunfu City People's Hospital between January 2021 and February 2023 were included based on predefined criteria.The patients were then divided into three groups according to their genotypes of theβ_(1)-adrenergic receptor Arg389Gly gene polymorphism:CC group(Arg389Arg),CG group(Arg389Gly),and GG group(Gly389Gly).Discrepancies in initial clinical data upon admission[such as Killip classification,heart rate,systolic and diastolic blood pressure,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVDD),and serum tumor necrosis factor alpha(TNF-α),N-terminal pro-B-type natriuretic peptide(NT-proBNP),creatine kinase MB(CK-MB)and high-sensitivity C-reactive protein(hs-CRP)],and outcomes gathered during a 6-month follow-up via telephone after discharge(heart rate,NT-proBNP,CK-MB,LVEF,LVDD,and occurrences of major adverse cardiac events)were compared across the three groups.RESULTS:The study enrolled a total of 178 STEMI patients with ventricular arrhythmias,comprising 87 cases in CC group(48.9%),73 cases in CG group(41.0%),and 18 cases in GG group(10.1%).There were no notable variances in demographic characteristics such as age,sex,weight,BMI,smoking history,alcohol consumption history,comorbidities,blood pressure,heart rate,Killip classification(Ⅲ amd Ⅳ),TNF-α,NT-proBNP,CKMB,hs-CRP,LVEF and LVDD across the three groups(P>0.05).Following a 6-month monitoring period,the cardiac function parameters in CG and GG groups exhibited significant improvement compared to those in CC group(P<0.05),with noteworthy lower levels of NT-proBNP and CK-MB in GG group in contrast to CG group(P<0.05).Notably,there were significant discrepancies in the incidence of major adverse cardiac events during the follow-up period among the study groups,with 17 cases in CC group(19.5%),5 cases in CG group(6.9%),and 1 case in GG group(5.6%)(χ^(2)=6.887,P<0.05).CONCLUSION:There is no correlation between the severity of STEMI accompanied by ventricular arrhythmias and theβ_(1)-adrenergic receptor Arg389Gly gene polymorphism.However,this gene variant is connected with enhancements in cardiac function and short-term prognosis post-treatment.