Association of the Platelet Glycoprotein Ia C807T Gene Polymorphism With Risk of Myocardial Infarction in Chinese

Objectives To investigate the relationship of the GPIa C807T dimorphism to the risk of myocardial infarction （MI） in Chinese. Methods We did a case-control study including 100 patients and 110 controls with same race. An allele-specific polymerase chain reaction （PCR） was used for genotyping of C807T polymorphism. Results An apparent association was found between the T807 allele and MI among individuals younger than the mean age of 60 years （odds ratio, 2. 49 ; 95 % confidence interval, 1.08 - 6.22 ）. The T807 allele remained an independent risk factor for MI when age, sex, smoking, hypertension, diabetes, bodymass index, LDL-cholesterol and HDL-cholesterol were adjusted by logistic regression. Conclusions GPIa T807 appears to be an independent risk factor for MI.

Distribution of gene polymorphisms associated with aspirin antiplatelet in the Han NSTEMI population

Objective:To analyze the genotype and allele distribution characteristics of GPⅢa PLA2(rs5918),PEAR1(rs12041331),and PTGS1(rs10306114)genes related to the antiplatelet pharmacological effects of aspirin,providing reference for individualized treatment of Chinese Han NSTEMI patients.Methods:A total of 107 Han patients with NSTEMI in Beijing Luhe Hospital affiliated to Capital Medical University from January 2016 to December 2022 were selected as the research subjects.The genotypes of GPⅢa PLA2(rs5918),PEAR1(rs12041331)and PTGS1(rs10306114)were detected by fluorescence staining in situ hybridization.The frequency distribution and allele distribution of genotype were analyzed.The results were analyzed whether there were statistical differences in the distribution of related alleles between the Han NSTEMI population and some populations in the 1000 Genomes database.Results:In the Han NSTEMI population,the genotype frequencies of GPⅢa PLA2(rs5918)locus were TT 97.20%,TC 2.80%and CC 0%,the allele frequencies were T 98.60%and C 1.40%.The genotype frequencies of PEAR1(rs12041331)locus were GG 42.06%,GA 44.86%and AA 13.08%,the allele frequencies were G 64.49%and A 35.51%.The genotypes at the PTGS1(rs10306114)locus were all AA(100%),no AG or GG genotype was found.Conclusion:In the NSTEMI population of Han nationality,the mutation at GPⅢa PLA2(rs5918)site related to aspirin antiplatelet pharmacology is rare,and there is no mutation at PTGS1(rs10306114)site.Wild homozygotes are dominant in these two gene loci,while mutations in PEAR1(rs12041331)are more common.Some of the findings in this study are similar to those in previous reports or other populations included in the relevant database;however,some results differ from previous reports or other populations。

Association of G+1688A Polymorphism of Platelet Endothelial Cell Adhesion Molecule-1 Gene with Myocardial Infarction in the Chinese Han Population

In order to investigate the association of G＋1688A （Ser563Asn） polymorphism of platelet endothelial cell adhesion molecule-1 （PECAM-1） gene with myocardial infarction （MI） in the Chinese Han population, the G＋1688A polymorphism in PECAM-1 gene was detected by polymerase chain reaction-restriction fragment-length polymorphism （PCR-RFLP） method among 502 subjects, including 218 patients with MI and 284 controls. The results showed that there was significant difference in AA frequencies of genotype G＋1688A polymorphism between case and control groups （39% vs 24%, P〈0.001）. A similar trend was observed on the allele frequencies （A/G： 62% vs 49%, P〈0.001）. Among the subjects with high serum total cholesterol level or high systolic blood pressure level, the variant AA genotype was associated with high risk of MI （adjusted OR, 2.13; 95% CI, 1.08 -4.41 and adjusted OR, 2.53; 95%CI, 1.63-3.63）. The single nucleotide polymorphism （SNP） at position ＋1688 in the exon 8 of PECAM-1 gene was associated with MI and the allele A might be a risk factor for MI in the Chinese Han population.

Association of IL33/ST2 Signal Pathway Gene Polymorphisms with Myocardial Infarction in a Chinese Han Population

This study investigated the relationship between IL-33/ST2 signal pathway gene polymorphisms and myocardial infarction（MI） in Han Chinese. A case-control association analysis was performed on a total of 490 MI patients（MI group） and 929 normal subjects（NC group）. Sequenom Mass Array and Taqman genotyping technique were used to analyze the tag single nucleotide polymorphisms（SNPs） in the genes encoding IL-33, ST2, and IL-1Ra P（rs11792633, rs1041973 and rs4624606）. The results showed that the frequencies of rs4624606 genotypes AA, TT, AT were 0.031, 0.647, 0.322 in MI group and 0.026, 0.712, 0.263 in NC group, and the allele frequencies of A and T were 0.192, 0.808 in MI group and 0.157, 0.843 in NC group. There were significant differences in rs4624606 genotypes and allele frequencies between MI group and NC group（P〈0.05）. For rs11792633, the allele frequencies of C and T were 0.45, 0.55 in MI group and 0.454, 0.546 in NC group with no significant differences found between the two groups. Compared with genotype CC＋TC, rs11792633 genotype TT had an increased risk of hypertension（P〈0.05）. However, there were no significant differences in the frequencies of rs11792633 genotypes between the two groups. No significant differences were noted in the frequencies of rs1041973 genotype and allele between the two groups. Logistic regression analysis showed that rs4624606 genotypes AT and AA＋AT were both significantly associated with MI（AT： OR=1.325, P=0.029, 95% CI=1.03–1.705; AA＋AT： OR=1.316, P=0.028, 95% CI=1.03–1.681） after factors such as age, gender, smoking, drinking, body mass index（BMI）, triglyceride（TG） and cholesterol were adjusted. Those carrying rs4624606 genotype AT or AA＋AT had an increased risk of MI. No associations were found between the polymorphisms of the other two loci with MI. It was concluded that, in the IL33/ST2 signal pathway, the A allele of rs4624606 polymorphism of IL-1Ra P gene is a potential independent risk factor for MI, and the genotypes AA＋AT and AT are associated with the incidence of MI.

Stromelysin-1 Gene Promoter 5A/6A Polymorphism and Plasma C-Reactive Protein in Patients with Coronary Artery Disease and Myocardial Infarction

Objective: To study the associations of stromelysin-1 (MMP3) gene 5A/6A polymorphism with plasma high-sensitivity C-reactive protein (hs-CRP) level in coronary artery disease (CAD) and myocardial infarction (MI). Methods: The MMP3 5A/6A genotypes and plasma hs-CRP levels were determined in 405 non-CAD subjects and 395 angiography-documented CAD patients, 157 with MI and 238 with non-MI. Results: The percentage of the 5A/5A genotype was significantly (p < 0.001) greater in CAD than non-CAD subjects and in MI than non-MI patients. Plasma hs-CRP level of the 5A/5A genotype was significantly (p < 0.05) higher than that of the 6A/6A genotype in CAD and MI but not in non-MI patients. On logistic regression analysis, the odds ratio of the 5A/5A genotype for CAD was 2.11 (95% CI, 1.15 - 3.88, p < 0.05) and for MI was 3.05 (95% CI, 1.54 - 6.04, p < 0.005). Conclusions: This study showed a correlation of the 5A/5A genotype of MMP3 promoter with higher plasma hs-CRP level in CAD patients with MI.

Correlation of eNOS gene G894T locus polymorphism with the oxidative and inflammatory endothelial function injury in patients with myocardial infarction

Objective:To study the correlation of endothelial nitric oxide synthase (eNOS) gene G894T locus polymorphism with the oxidative and inflammatory endothelial function injury in patients with myocardial infarction.Methods:87 patients with acute myocardial infarction treated in our hospital between May 2012 and December 2015 were selected as acute myocardial infarction (AMI) group and 90 healthy volunteers receiving physical examination during the same period were selected as control group. Peripheral arterial blood was collected to extract genomic DNA and then determine eNOS gene G894T locus polymorphism;peripheral venous blood was collected to separate serum and then determine endothelial injury, oxidative stress and inflammatory reaction indexes.Results:GG genotype proportion and G allele frequency of eNOS gene G894T locus of AMI group were significantly lower than those of control group (P<0.05) while the GT genotype and TT genotype proportion as well as T allele frequency were significantly higher than those of control group (P<0.05);serum nitric oxide (NO), SOD and GSH content of patients with GG genotype were significantly higher than those of patients with GT genotype and TT genotype (P<0.05) while vWF, ET-1, ox-LDL, MDA, -COOH, NF-κB, MCP-1, IL-6 and IL-18 content were significantly lower than those of patients with GT genotype and TT genotype (P<0.05).Conclusions: The proportion of eNOS gene G894T locus G mutation into T significantly increases in patients with myocardial infarction, and G894T locus G mutation into T can aggravate the endothelial injury caused by oxidative stress and inflammation.

Genotype frequency of gelatinase B C-1562 T polymorphism in coronary heart disease and myocardial infarction

Background One of the characteristics of atherosclerosis is a change in the content of extracellular matrix in the arterial wall. Gelatinase B, a member of the family of matrix metalloproteinase, can regulate extracellular matrix metabolismand play a role in the pathogenesis of atherosclerosis, coronary heart disease (CHD) and myocardial infarction (MI). Gelatinase B is polymorphic due to a C to T change at the position -1562 bp in the promoter region.Its relationship with gene product concentration in serum and its role in mediating the risk of CHD and MI in Germans is still unknown. Methods We enrolled 102 controls and 322 patients with angiographically documented CHD,including a sub-group of 173 patients with acute or chronic MI and 80 patients with acute coronary syndrome (ACS).All patients and controls were Germans and genotyped by polymerase chain reaction and digestion with SphI. Results We found that several classical risk factors for CHD and MI, including hypercholesterolemia and cigarette smoking,were significantly increased in CHD and MI patients compared with controls. Serum levels of gelatinase B and tissue inhibitor of metalloproteinase-1 were increased in the peripheral blood of patients with acute coronary syndrome. No significant differences in genotype or allelic frequencies between CHD, MI and control subjects of either men or women were found. Our search for a possible association of the polymorphisms with CHD and MI by logistic regression analysis was also negative. The serum concentrations of gelatinase B showed no differences between genotypes. Conclusions Our data showed that gelatinase B might provide an index of plaque activity in ACS, but gelatinase B protein was not affected by genotypes. Also, the T variant of gelatinase B was not associated with CHD or MI in Germans. (J Geriatr Cardiol 2004;1(2):114-118.)

Acute ST-Segment Elevation Myocardial Infarction: Combined Intracoronary Low Dose Eptifibatide and Thrombus Aspiration

Aim of the work: To evaluate the efficacy and safety of bolus only intra coronary platelet glyco-protein GP IIb/IIIa receptor antagonists combined with thrombus-aspiration during percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). Patient and Methods: 25 consecutive STEMI patients treated by primary PCI including thrombus aspiration were prospectively enrolled, from a total of 180 PCIs performed at our institution between January 2013 and January 2014. All patients received aspirin (250 mg i.v.) and clopidogrel (600 or 300 mg if already on clopidogrel) plus standard heparin. Glycoprotein IIb/IIIa antagonists were administered at physicians’ discretion before thrombus aspiration. Eptifibatide was used as a slandered Glycoprotein IIb/IIIa antagonists as a dose of the 180-μg/kg eptifibatide bolus only. The bolus was administered for 2 minutes via the thrombus aspiration catheter (STEMI cath of min-vasys) just before thrombus aspiration. Twelve-lead ECGs were recorded at baseline and 60 min (45 - 75 min) after completion of PCI. The primary endpoint was the TIMI 3 patency of the infarct-related coronary artery before PCI. Secondary endpoints were TIMI patency following PCI, ST resolution 60 min after PCI, all-cause death, reinfarction, urgent revascularization, stroke (haemorrhagic, non-haemorrhagic), and severe bleeding complications. Results: The angiography was performed in all 25 patients. The incidence of a TIMI flow grade 3 of the infarct-related coronary artery before PCI was 16% while TIMI grade 2 and I was 24% and 36% respectively. The incidence of a TIMI flow grade 0 (no reflow) of the infarct-related coronary artery before PCI was 24%. Visible thrombus in 52% of patients and 40% of patients have more than one critically disease vessel. Primary PCI was performed in 25 patients. Eptifibatide intracoronary was given through thrombus aspiration catheter before thrombus aspiration. Drug eluting stents were implanted in 60% of patients. Only two patients with acute stent thrombosis did not receive any stents at PCI. One patient died 24 h after the procedure due to severe heart failure and cardiogenic shock. No reinfarction was noted within 30 days after the procedure. Generally heart failure improved significantly after the procedure and at the end of 30 day post operative. Only 3 patients had persistent heart failure class III (12%). 84% of patients had TIMI flow III at the end of procedure with over all significant improvement. Significant TIMI flow improvement after procedure was noticed with P value, 001. Also the results showed significant shows of ST segment resolution after procedure. Conclusions: for patients with STEMI undergoing primary PCI, a routine combination of intracoronary administration of Eptifibatide before transcatheter thrombus aspiration is a safe procedure with low risk of hemorrhage and increases myocardial reperfusion, which ultimately improves outcomes. This therapeutic modality may be recommended for further improving myocardial reperfusion in patients with STEMI.

阿司匹林抗血小板相关基因多态性在汉族NSTEMI患者人群中的分布

目的:分析汉族非ST段抬高型心肌梗死(NSTEMI)患者人群中与阿司匹林抗血小板药理作用相关的GPⅢa PLA2(rs5918)、PEAR1(rs12041331)和PTGS1(rs10306114)基因的基因型结果及等位基因分布特征,为汉族NSTEMI患者的个体化治疗提供参考。方法:选取2016年1月~2022年12月首都医科大学附属北京潞河医院收治的汉族NSTEMI患者107例为研究对象。采用荧光染色原位杂交的方法对GPⅢa PLA2(rs5918)、PEAR1(rs12041331)和PTGS1(rs10306114)3个基因多态性位点进行检测分型,研究分析其基因型频率分布及等位基因分布情况,并分析汉族NSTEMI患者人群与1000 Genomes数据库中部分人群相关等位基因的分布是否存在统计学差异。结果:汉族NSTEMI患者人群中,GPⅢa PLA2(rs5918)位点上基因型频率为TT 97.20%、TC 2.80%、CC 0%,等位基因频率为T 98.60%、C 1.40%;PEAR1(rs12041331)位点上基因型频率为GG 42.06%、GA 44.86%、AA 13.08%,等位基因频率为G64.49%、A 35.51%;PTGS1(rs10306114)位点上基因型均为AA(100%),未见AG或GG型。结论:在汉族NSTEMI患者人群中,与阿司匹林抗血小板药理作用相关的GPⅢa PLA2(rs5918)位点上突变少见,PTGS1(rs10306114)位点上未见突变,这2个多态性位点上均以野生型纯合子为主,而PEAR1(rs12041331)位点上突变多见。本研究中部分结果与既往报道或相关数据库中收录的其他人群类似,也有部分结果与既往报道或其他人群存在明显差异。

Relationship between gene polymorphism of the PAI-1 promoter and myocardial infarction

目的 探讨组织型纤溶酶原激活物抑制物 1(PAI 1)启动子基因多态性与中国汉族人心肌梗死发病的关系。方法 采用多聚酶链反应—限制性内切酶片段长度多态 (PCR—RFLP)与等位基因特异PCR (ASPCR)法确定 87例心肌梗死患者和 92例无亲缘关系的正常对照者启动子上游基因型多态 ,同时检测受试者临床指标及PAI 1的活性。结果 PAI 1基因启动子上游— 84 4bp处存在G/A置换多态及 - 6 75bp处 4G/ 5G缺失 /插入多态。病例组与对照组间GG、GA、AA基因型频率及PAI 1活性均无明显差别。心肌梗死组与对照组相比 4G/ 4G型频率明显增高 (P<0 0 5) ,病例组 4G/ 4G型PAI 1活性明显高于 5G/ 5G型 (P <0 0 5) ,且血糖水平与PAI 1活性间有明显正相关关系 (r=0 34,P =0 0 2 )。结论 PAI 1启动子基因多态性与心肌梗死发病相关。 4G/ 4G型可能是发病的重要危险因素。血糖对调节PAI

海南汉族和黎族人群PCSK9基因E670G多态性与急性心肌梗死的相关性

目的研究海南地区黎、汉族人群PCSK9基因E670G多态性与急性心肌梗死的相关性,为不同种族人群心肌梗死的预防、治疗提供科学基础依据。方法选取海南地区急性心肌梗死患者210例(黎族104例,汉族106例)为实验组、健康人群223名(黎族110名,汉族113名)为对照组,测定两组研究对象血清三酰甘油(triacylglycerol,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein-cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)浓度,采用聚合酶链反应-限制性片段长度多态性(polymerase chain reaction linked restriction fragment length polymorphism,PCR-RFLP)检测PCSK9基因E670G酶切位点多态性。结果心肌梗死组患者血压、空腹血糖(fasting blood glucose,FBG)、TG、TC、LDL-C浓度高于健康对照组,HDL-C浓度低于健康对照组,差异有统计学意义(P<0.05)。心肌梗死组患者PCSK9基因AG、GG基因型频率及G等位基因频率高于健康组,差异有统计学意义(P<0.05)。黎族、汉族心肌梗死组患者AG、GG基因型频率、G等位基因频率均高于健康组,差异有统计学意义(P<0.05)。黎族心肌梗死组患者GG基因型频率、G等位基因频率低于汉族心肌梗死组,差异有统计学意义(P<0.05)。黎族、汉族健康对照组GG基因型频率、G等位基因频率比较,差异无明显统计学意义(P>0.05)。心肌梗死组中GG基因型患者的TG、TC、LDL-C浓度高于AA基因型;AG与AA、GG与AG基因型患者间TG、TC、HDL-C、LDL-C浓度比较,差异无统计学意义(P>0.05),但与AA基因型相比,G等位基因携带者有较高的TG、TC、LDL-C浓度趋势。结论海南地区黎、汉族人群PCSK9基因E670G多态性与急性心肌梗死及血脂浓度密切相关;海南地区黎、汉族人群急性心肌梗死患者PCSK9基因E670G多态性存在差异。

Polymorphisms in the coagulation factor Ⅶ gene and the risk of myocardial infarction in patients undergoing coronary angiography

Objective To investigate whether coagulation factor Ⅶ (FⅦ) polymorphisms play a role in the pathogenesis of coronary artery disease (CAD) and/or myocardial infarction (MI) in a series of Hans.Methods The Arg 353 Gln and HVR4 polymorphisms of FⅦ gene were determined in 374 patients undergoing selective coronary angiography by PCR and restriction fragment length polymorphism assay.Results The FⅦ genotype distribution was in accordance with Hardy-Weinberg equilibrium. The frequencies of FⅦ genotypes or alleles did not show significant differences between the CAD group and the controls or between the males and the females. The frequencies of carriers of the Gln 353 allele and (Arg/Gln+Gln/Gln) genotypes were significantly higher in the CAD patients without MI than in those with MI ( P =0.031,odds ratio 0.37,95% CI: 0.15-0.94). However,HVR4 polymorphisms were not significantly different between the two groups ( P >0.05).Conclusion Carrying the F Ⅶ Gln 353 gene may be a protective factor against MI in the Chinese Hans.

血清ST2、PLA2、血小板活化物对急性心肌梗死患者PCI术后MACE事件的预测价值

目的 探讨血清可溶性生长刺激表达基因2蛋白(ST2)、磷脂酶A2 (PLA2)、血小板活化物对急性心肌梗死患者经皮冠状动脉介入(PCI)术后心血管不良事件(MACE)事件的预测价值。方法 选择2020年1月至2021年12月我院接诊的155例急性心肌梗死患者,PCI术后随访6月,术后发生MACE的45例设为MACE组,110例术后未发生MACE的设为对照组,分析两组一般临床资料、血清ST2、PLA2、血小板活化物水平变化情况,分析急性心肌梗死患者PCI术后MACE事件的危险因素,采用ROC曲线分析血清ST2、PLA2、血小板活化物对PCI术后MACE事件的预测价值。结果两组年龄、性别、体质指数、糖尿病史比较差异无统计学意义(P>0.05),MACE组舒张压、收缩压低于对照组,心率及心衰病史高于对照组,比较差异显著(P<0.05);MACE组患者血清ST2、PLA2、PAC-1、CD40L及CD62p水平显著高于对照组,比较差异具有统计学意义(P<0.05);多因素非条件Logistic分析显示,血清ST2、PLA2、PAC-1、CD40L及CD62p均是PCI术后MACE事件发生的独立危险因素。对血清ST2、PLA2、PAC-1、CD40L及CD62p预测PCI术后MACE事件进行ROC曲线分析,结果显示,血清ST2、PLA2、PAC-1、CD40L及血清CD62p预测PCI术后MACE事件发生的截断值分别为20.69 ng/ml、273.87 ng/ml、9.01%、1.90%及6.63%,(P<0.05)。结论 血清ST2、PLA2、血小板活化物均是急性心肌梗死患者PCI术后MACE事件的危险因素,在心血管不良事件的发生中有一定的预测价值。

TET 2基因单核苷酸多态性与急性心肌梗死易感性和临床特征及预后的相关性分析

目的探讨TET 2基因单核苷酸多态性(SNP)与急性心肌梗死(AMI)易感性、临床特征及预后的相关性,为临床探究AMI发病的分子遗传学提供理论基础及实验依据。方法选取2022年1-10月在承德医学院附属医院确诊的AMI患者及同期相匹配的健康体检人群各100例为研究对象,分为AMI组和对照组。统计TET 2基因2个SNP位点rs7670522、rs6839705基因型(AA、AG、GG)、等位基因(A、G)在AMI不同分类易感性(对照组、AMI组)、临床特征(有无临床典型症状、严重并发症)、预后(死亡、存活)中的分布规律。采用多因素Logistic回归方法分析AMI患者预后的影响因素。结果AMI组rs7670522、rs6839705位点AA基因型、A等位基因频率均高于对照组,差异均有统计学意义(均P<0.05)。AMI患者中有典型症状组rs7670522、rs6839705位点AA基因型、A等位基因频率均明显高于无典型症状组,有严重并发症组rs7670522、rs6839705位点AA基因型、A等位基因频率均明显高于无严重并发症组(均P<0.05)。AMI患者中死亡组rs7670522、rs6839705位点AA基因型、A等位基因频率均明显高于存活组(均P<0.05)。多因素Logistic回归分析结果显示,TET2 rs7670522、TET2 rs6839705均与AMI患者预后密切相关(比值比=3.244、3.095,P=0.004、0.006)。结论TET 2基因2个SNP位点rs7670522、rs6839705多态性与AMI易感性、临床特征及预后存在相关性,基因型AA、等位基因A均是导致患者预后不良的关键因素。

TET2基因单核苷酸多态性与急性心肌梗死易感性的关系

目的探讨TET2基因单核苷酸多态性(rs2454206、rs12498609)与急性心肌梗死易感性的相关性。方法前瞻性选取2022年1月-2022年9月承德医学院附属医院收治的急性心肌梗死患者作为病例组,另选取同期该院健康人群作为对照组,每组150例。比较两组一般资料及血脂相关指标,采用实时荧光定量聚合酶链反应(qRT-PCR)检测TET2基因rs2454206、rs12498609位点基因型,采用多因素Logistic逐步回归分析影响急性心肌梗死发生的危险因素。结果两组TET2基因rs2454206位点、rs12498609位点基因型频率、等位基因频率比较,差异均有统计学意义(P<0.05)。多因素Logistic逐步回归分析显示,高血压[OR=2.022(95%CI:1.202,3.401)]、TC[OR=3.045(95%CI:2.146,4.320)]、TG[OR=4.052(95%CI:2.405,6.826)]、LDL-C[OR=3.022(95%CI:1.889,4.834)]、rs2454206位点AA基因型[OR=4.697(95%CI:2.675,8.249)]、rs12498609位点CC基因型[OR=2.147(95%CI:1.215,3.795)]是影响急性心肌梗死发生的危险因素(P<0.05),HDL-C[OR=0.057(95%CI:0.015,0.216)]是影响急性心肌梗死发生的保护因素(P<0.05)。结论急性心肌梗死的发生受多种因素影响,其中TET2基因rs2454206位点AA基因型、rs12498609位点CC基因型可能与急性心肌梗死易感性增加有关。

APOE基因多态性与急性心肌梗死患者PCI术后近期主要不良心血管事件的临床关系分析

目的探讨载脂蛋白E(APOE)基因多态性与急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后近期主要不良心血管事件(MACE)的临床关系。方法选取于周口市中心医院行PCI术的192例AMI患者为观察组,另选取165例健康体检者为对照组,检测APOE基因多态性。根据PCI术后近期MACE发生情况将AMI患者分为发生组与未发生组,对比APOE等位基因、基因型分布情况,分析其与术后近期MACE的关系。结果观察组等位基因E4与基因型E3/4、E4/4分布频率高于对照组(P<0.05),等位基因E2与基因型E2/3分布频率低于对照组(P<0.05);术后6个月,MACE发生率为19.79%;发生组等位基因E4与基因型E3/4、E4/4分布频率高于未发生组(P<0.05),等位基因E2与基因型E2/3分布频率低于未发生组(P<0.05);年龄、术前Gensini评分、病变支数、梗死部位数、高血压、糖尿病、高血脂症、术后慢/无复流以及等位基因E4与E2均是AMI患者PCI术后近期发生MACE的影响因素(P<0.05)。结论APOE基因中的E4与E2等位基因与AMI患者PCI术后近期MACE的发生密切相关。

平均血小板体积/血小板计数、血小板α颗粒膜糖蛋白对经皮冠状动脉介入治疗即刻血流分级及预后的预测价值

目的 探讨平均血小板体积(MPV)/血小板计数(PC)、血小板α颗粒膜糖蛋白(CD62P)预测经皮冠状动脉介入治疗(PCI)即刻血流分级及预后的价值。方法 选取2018年5月至2020年2月河南省直属机关第一门诊部收治的41例PCI即刻心肌梗死溶栓治疗临床试验(TIMI)血流分级0~Ⅱ级病人(观察组)及41例PCI即刻TIMI血流分级Ⅲ级病人(对照组),比较两组及是否发生主要心血管不良事件(MACE)病人的MPV/PC、CD62P指标水平。以logistic回归方程进行多因素分析,采用受试者操作特征曲线(ROC)分析各指标对预测评估PCI即刻血流分级、预后的效能。结果 观察组MPV/PC 0.05±0.02、CD62P(52.26±14.47)%高于对照组的0.04±0.01、(38.87±12.76)%(P<0.05)。MPV/PC、CD62P仍是PCI即刻血流分级的独立相关危险因素(P<0.05);预测PCI即刻血流分级的ROC曲线下面积(AUC):MPV/PC为0.78,CD62P为0.81,MPV/PC+CD62P为0.86(P<0.05);MACE病人MPV/PC 0.06±0.02、CD62P(60.19±15.02)%高于无MACE者的0.05±0.01、(41.75±11.27)%(P<0.05);预测MACE的AUC:MPV/PC为0.76,CD62P为0.80,MPV/PC+CD62P为0.84(P<0.05)。结论 MPV/PC、CD62P均与PCI即刻TIMI血流分级有关,并能相互影响,两者联合具有较高的血流分级、MACE预测价值,有望成为预测PCI病人即刻血流分级和MACE的新方案。

CYP2D6基因多态性对美托洛尔治疗急性心肌梗死的药效影响研究

目的探讨CYP2D6基因多态性对美托洛尔治疗急性心肌梗死药效的影响。方法68例给予美托洛尔口服治疗的急性心肌梗死患者根据基因检测结果分为CC组、CT组和TT组,比较三组的心功能指标、cTnT、NT-proBNP和美托洛尔血药浓度。结果治疗后,TT组的LVEDD、cTnT、NT-proBNP水平均低于CC组和CT组,LVEF高于CC组和CT组(P<0.05)。TT组的美托洛尔血药浓度高于CC组和CT组(P<0.05)。结论美托洛尔治疗急性心肌梗死的临床效果与CYP2D6基因多态性密切相关,CYP2D6纯合突变型患者的美托洛尔血药浓度较高,因此疗效较好。

冠状动脉内注射替罗非班对老年糖尿病急性心肌梗死患者的影响

目的探讨冠状动脉内注射替罗非班对老年糖尿病合并急性心肌梗死(AMI)患者急诊PCI的近期疗效和安全性。方法选择急诊PCI的老年糖尿病合并AMI患者97例,随机分为对照组(A组)49例、替罗非班组(B组)48例;另选择同期急诊PCI给予替罗非班治疗的非老年糖尿病合并AMI患者(C组)129例。对3组冠状动脉病变特征、并发症发生率等进行比较。结果与A组比较,B组和C组PCI术后TIMI 3级血流、心肌灌注3级明显升高(P<0.01),心肌灌注0～1级、2级、平均住院天数、梗死后心绞痛、恶性心律失常发生率明显降低(P<0.05,P<0.01)。3组单支、双支和3支病变、入院到球囊扩张平均时间、住院期间再梗死、支架内血栓、心源性休克发生率和30d病死率等无明显变化(P>0.05)。结论替罗非班能有效改善老年糖尿病合并AMI患者的TIMI血流和心肌灌注分级,降低梗死后心绞痛、恶性心律失常等并发症的发生。并不增加严重出血并发症。

半量替罗非班在老年急性心肌梗死急诊经皮冠状动脉介入治疗的疗效和安全性

目的 探讨半量替罗非班对老年急性ST段抬高心肌梗死（STEMI）患者急诊PCI的疗效及安全性.方法 入选STEMI行急诊PCI老年患者114例,随机分为标准剂量组56例和半量组58例.标准剂量组给予替罗非班0.10~0.15 μg/（kg·min）静脉滴注48 h,半量组给予0.05~0.075 μg/（kg·min）静脉滴注24 h.比较2组TIMI及心肌染色分级（MBG）2~3级血流率,术后90 min的ST段回落百分比（sumSTR）、LVEF、左心室舒张末和收缩末内径变化及主要心脏不良事件、出血、消化道不良反应的发生率.结果 标准剂量组TIMI及MBG 2~3级血流率较半量组虽有升高趋势,但差异无统计学意义（P〉0.05）;2组术后90 min的sumSTR〉50%比例及患者住院期间不良事件发生率比较,差异无统计学意义（P〉0.05）;半量组出血发生率低于标准剂量组（3.45% vs 16.07%,P〈0.05）.结论 半量替罗非班在预防缺血方面的疗效与标准剂量相当,但在出血风险方面的安全性明显升高.