冠脉介入治疗后止凝血功能的改变及其与PAI基因多态性的关系

J4 ›› 2009, Vol. 35 ›› Issue (3): 522-526.

冠脉介入治疗后止凝血功能的改变及其与PAI基因多态性的关系

孙敏¹, 吴金义², 侯俭³, 李双斌³

1.北华大学医学检验学院血液检验教研室|吉林吉林132013；2.吉林大学中日联谊医院心内科|吉林长春130033;3. 吉林省吉林市中心医院心内科| 吉林吉林 132011

收稿日期:2008-11-21 出版日期:2009-05-28 发布日期:2009-08-14
通讯作者: 李双斌 E-mail:dfbzxy@tom.com
作者简介:孙敏（1964-）|女|吉林省吉林市人|副教授| 医学硕士 |主要从事血栓及出血性疾病的研究。
基金资助:
吉林省科技厅科研基金资助课题(20080440-1)

Changes of |homeostatic activation in patients after percutaneous coronary intervention |　and its relationship |with |plasminogen activator inhibitor-1 |gene polymorphism

SUN Min¹, TUN Jin-Xi², HOU Jian³, LI Shuang-Bin³

1.Department of Hematologic Examination,College of Medical Examination,Beihua University,Jilin 132013,China；2.Department of Cardiology,China-Japan Union Hospital,Changchun 130033, China；3. Department of Cardiology| Central Hospital of Jilin,Jilin |132011,China

Received:2008-11-21 Online:2009-05-28 Published:2009-08-14

摘要/Abstract

摘要：

目的：探讨经皮冠状动脉介入术( PCI)后止凝血功能变化与纤溶酶原激活剂抑制物-1 (PAI-1) 基因启动子区-675 4G/5G 多态性的关系，为临床PCI后预测血栓形成提供依据。方法：86例行PCI的冠心病患者分别于术前、术后即刻、术后24 h肘静脉采血,检测血浆中血管性血友病因子( vWF) 、PAI-1、FⅦc活性及血小板α颗粒膜蛋白-140（GMP-140 ）、D-二聚体(D-D)含量;应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法检测基因型及不同基因型患者PCI前、后止凝血功能指标。结果：PAI-1 基因型频数分布为4 G/4 G 型48 例（56%）,4 G/5 G30 例（35%）,5 G/5 G 型 8 例（9%）。4 G 和5 G 等位基因频率分别为73%和27%。3组基因型患者术前各项指标比较差异无显著性（P>0.05）。具有PAI-1 4G/4G 基因型患者血浆vWF、PAI-1、FⅦc活性及GMP-140、D-D含量在术后即刻高于术前( P< 0.01)；术后24 h PAI-1活性高于术前(P< 0.01)，但vWF、FⅦc活性及GMP-140、D-D含量有所下降,与术前比较差异无显著性（P>0.05）。具有4G/5G基因型及5G/5G基因型的两组患者术后即刻各项指标较术前明显增高( P< 0.01)；术后24 h较术前有增高趋势,但差异均无显著性（P>0.05）。4 G/4 G 型患者术后即刻及术后24 h PAI-1活性较另两组基因型患者增高更显著( P< 0.01)；其他指标有增高趋势，但差异无显著性(P>0.05)。结论：具有PAI-1 4 G/4G 基因型患者在PCI后较4 G/5 G型及5 G/5 G 型患者存在明显的纤维蛋白溶解功能的改变，提示PAI-1 4G/4G基因可能是PCI后急性和亚急性冠状动脉血栓形成的危险基因型。

关键词: 经皮冠状动脉介入术, 多态性,单核苷酸；纤溶酶原激活剂抑制物-1;凝血因子Ⅶ;血小板α颗粒膜蛋白-140, D- 二聚体

Abstract:

To investigate the relationship between plasminogen activatorinhibitor-1 (PAI-1) 4G/5G gene polymorphism and homeostatic activation after percutaneous coronary intervention（PCI），and provide foundation for clinic detection of thrombosis after PCI.Methods The plasma von Willebrand factor（vWF）,activated factor Ⅶ ( FⅦc) ,PAI-1 activities and GMP-140, D-dimers(D-D) levels in 86 patients with coronary heart disease undergoing in-stent implantation were determined before and immediate postoperative,and 24 h after PCI.PAI-1 gene polymorphism was detected by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) to observe the changes of platelet function and coagulation and fibrinolytic states before and after PCI.Results The distribution of PAI-1 genotypes was as follows:48 cases with 4G/4G (56%),30 cases with 4G/5G (35% )and 8 cases with 5G/5G ( 9%).Among the patients,the allelic frequencies of 4G and 5G were 73% and 27% respectively.No significant difference of the plasma GMP-140,vWF,FⅦa,D-D and PAI-1 levels was found between the three genotypes before PCI (P>0.05).In the patients with 4G/4G polymorphism of PAI-1 gene,the GMP-140,vWF,FⅦa,D-D and PAI-1 levels in plasma were significantly increased at immediate postoperative period(P<0.01).The PAI-1 levels in plasma were significantly increased 24 h after PCI(P< 0.01);but the GMP-140,vWF,FⅦa and D-D levels did not significantly increase (P>0.05).In the patients with 4G/5G and 5G/5G genotypes, all indexes mentioned above were significantly increased at immediate postoperative period (P<0.01);24 h after PCI there were no significant differences (P>0.05).In the patients with 4G/4G genotype, the PAI-1 level in plasma was significantly higher than those in the patients with 4G/5G and 5G/5G genotypes 24 h after PCI(P< 0.01).
Conclusion There is a remarkable homeostatic activation and the fibrinolytic activity changes more in patients with 4G/4G genotype than those in patients with 4G/5G and 5G/5G genotypes after PCI.The results suggest that the patients with 4G/4G genotype may be a dangerous factor in acute or subacute coronary thrombosis after PCI

Key words: percutaneous coronary intervention, polymorphism, single nucleotide； plasminogen activator inhibitor-1;GMP-140;factor Ⅶ;D-Dimer

中图分类号:

R541.4

孙敏, 吴金义, 侯俭, 李双斌. 冠脉介入治疗后止凝血功能的改变及其与PAI基因多态性的关系[J]. J4, 2009, 35(3): 522-526.

[1]	刘然,颜红兵,郑斌,宋莉. 急性心肌梗死接受直接冠状动脉介入治疗患者血脂水平与预后的关联性分析[J]. J4, 2011, 37(5): 873-879.
[2]	黄妍, 李法琦, 李万玉, 周平, 周希, 赵玉伟, 邱炯. 急性心肌梗死大鼠血管紧张素Ⅱ对PAI-1和tPA表达的作用及其机制[J]. J4, 2011, 37(1): 41-46.
[3]	周丽婷, 史杰萍, 叶琳, 崔建林, 王春华, 隋春生, 刘特, 梁楠. 中国汉族人群脂蛋白脂酶Pvu Ⅱ基因多态性与冠心病关系的Meta-分析[J]. J4, 2010, 36(2): 405-407.
[4]	卜丽梅\|吴绥生\|贺宏英. 奥扎格雷钠对大鼠心肌缺血的抗氧化作用[J]. J4, 2009, 35(4): 631-634.
[5]	吴源, 高东梅, 宋军, 周雪艳, 孟繁波, 曾红. 曲美他嗪对冠心病患者血管内皮功能的改善作用[J]. J4, 2009, 35(4): 685-689.
[6]	谢英, 刘弢, 周玉杰, 马涵英, 郭永和, 李月平, 刘宇扬, 赵迎新, 史冬梅, 成万军. 高危急性冠脉综合征患者介入治疗不同时机应用替罗非班减少心肌损伤效果的[J]. J4, 2009, 35(3): 549-552.