重度血瘀证与血浆遗传性假血友病因子水平及CYP2C19*2基因多态性的关系  

Correlation of Severe Blood-stasis Syndrome,Plasma Von Willebrand Factor and Polymorphism of CYP2C19*2 Gene

作　　者：张娅[1] 陈慧[2] 李灿东[1] 吴红霞[2] 林云钗[2] 

机构地区：[1]福建中医药大学中西医结合研究院中医证研究基地,福州市闽侯上街华佗路1号350108 [2]福建医科大学省立临床医学院心内科

出　　处：《中医杂志》2011年第11期941-944,951,共5页Journal of Traditional Chinese Medicine

基　　金：卫生部科学研究基金-福建省卫生教育联合攻关计划项目(WKJ2008-2-059)

摘　　要：目的探讨经皮冠状动脉介入术（PCI）后重度血瘀证与血浆遗传性假血友病因子（vWF）水平及CYP2C19＊2基因多态性的相关性。方法将371例PCI成功的冠心病患者根据术后1周血瘀证评分标准分为非血瘀组（77例）、轻度血瘀组（193例）和重度血瘀组（101例）3组,采用PCR-RFLP基因分析方法检测CYP2C19＊2基因多态性,同时采血检测血小板计数（PLT）、最大血小板聚集率（MPA）、vWF和纤维蛋白原（Fg）。结果重度血瘀组CYP2C19＊2基因突变型（GA＋AA）明显高于轻度血瘀组和非血瘀组（χ2=27.093,P〈0.001）。多因素Logistic回归分析显示,以非血瘀组为参照系,CYP2C19＊2基因突变型（GA＋AA）患重度血瘀证的相对危险度（OR）为3.371（95%CI：1.557~7.295,P=0.002）。重度血瘀组MPA及vWF高于轻度血瘀组,差异有统计学意义（P〈0.05）。血浆vWF的ROC曲线分析指出,vWF≥118.10%（敏感性为0.842,特异性为0.767,辨证准确率为78.6%,Youden指数0.609）,中医辨证为重度血瘀证的可能性较大。结论 PCI术后CYP2C19＊2基因突变患者可能易患重度血瘀证,血浆vWF测定可作为其重要的微观辨证指标。Objective To approach the correlation among severe blood-stasis syndrome,plasma von Willebrand factor（vWF） and polymorphism of CYP2C19＊2 gene in the patients after percutaneous coronary intervention（PCI）.Methods Totally 371 coronary heart disease patients after receiving successful PCI were adopted in this study.One week after operation,they were divided into three groups according to the scoring criteria of blood-stasis syndrome,i.e.non blood-stasis group（77 cases）,mild blood-stasis group（193 cases）,and severe blood-stasis group（101 cases）.The PCR-RFLP gene analyzing method was adopted to detect the polymorphism of CYP2C19＊2 gene.At the same time,the platelet count,maximum platelet aggregation（MPA） rate,vWF,and fibrinogen（Fg） were tested.Results Mutations GA＋AA of CYP2C19＊2 gene was higher in the severe blood-stasis group than in the other two groups（χ2=27.093,P0.001）.The multifactor logistic regression analysis indicated that taking the non blood-stasis group as control,after adjusting all common risk factors,the odds ratios（OR） of GA＋AA of CYP2C19＊2 gene diseased with severe blood-stasis was 3.371（95%Cl： 1.557-7.295,P=0.002）.MPA and vWF of the severe blood-stasis group were higher than those of mild blood-stasis group,and the difference was statistically significant（P0.05）.The ROC curve of vWF indicated that those patients were more likely to be severe blood-stasis when vWF ≥ 118.10%（sensitivity 0.842,specificity 0.767,syndrome differentiation accuracy 78.6%,and Youden index 0.609）.Conclusion Those who have CYP2C19＊2 gene mutation after PCI are susceptible to severe blood-stasis,and vWF serves as an important concrete indicator of syndrome differentiation.

关 键 词：经皮冠状动脉介入术 冠心病 血瘀证 遗传性假血友病因子 CYP2C19＊2 基因多态性 

分 类 号：R541.4[医药卫生—心血管疾病]