抗凝血酶Ⅲ基因多态性与不同民族患者肝素抗凝效应差异的关系  

Relationship between antithrombin Ⅲ genetic polymorphism and individual variation in anticoagu-lant effect of heparin in patients of different nationalities

作　　者：马海平[1] 艾来提·塔来提[1] 王江[1] 姜巧巧[1] 郑宏[1] 

机构地区：[1]新疆医科大学第一附属医院麻醉科,乌鲁木齐市830054

出　　处：《中华麻醉学杂志》2017年第11期1374-1377,共4页Chinese Journal of Anesthesiology

基　　金：新疆维吾尔自治区自然科学基金（2015211C058）

摘　　要：目的评价抗凝血酶Ⅲ（ATⅢ）基因多态性与不同民族患者肝素抗凝效应差异的关系。 方法选择体外循环下行心脏手术的维吾尔族和汉族患者各60例，分别为维吾尔族组和汉族组，年龄18～64岁，性别不限，体重指数21～25 kg/m2，ASA分级Ⅰ-Ⅲ。术前用聚合酶链反应法进行ATⅢ基因多态性检测（A/G为杂合子型，A/A和G/G为纯合子型）。体外循环开始前5 min静脉注射肝素钠注射液，用量以ACT≥480 s为标准。记录肝素和鱼精蛋白用量、术中输血情况、术后24 h引流量（心包、纵膈/胸腔）。于术前10 min及术后24 h抽静脉血标本检测APTT和PT。 结果与汉族组比较，维吾尔族组肝素用量、鱼精蛋白/肝素中和比例和术中输血率降低，术后引流量减少，术后24 h时APTT缩短，ATⅢ基因单核苷酸多态性位点rs5877和rs5878的A/A基因型频率升高，G/G基因型频率降低，最小等位基因（A〉G）型频率升高（P〈0.05）。 结论ATⅢ基因多态性可能是维吾尔族和汉族患者肝素抗凝效应差异的机制之一。Objective To evaluate the relationship between antithrombin Ⅲ（AT） genetic pol- ymorphism and individual variation in anticoagulant effect of heparin in the patients of different nationalities. Methods Sixty patients of Uighur nationality and 60 patients of Han nationality, aged 18-64 yr, with body mass index of 21-25 kg/m2, of American Society of Anesthesiologists physical status I -Ⅲ, undergo- ing elective cardiac surgery under eardiopulmonary bypass, were divided into Uighur group and Han group, respectively. ATⅢ gene polymorphism was detected by polymerase chain reaction （A/G was heterozygous, A/A and G/G were homozygous）. Heparin sodium was intravenously injected at 5 rain before the start of cardiopuhnonary bypass with an amount of ACT 〉i 480 s. The amount of heparin and protamine, intraoper- ative blood transfusion and postoperative 24 h drainage （pericardium, mediastinum/tboraeic cavity） were recorded. Activated partial thromboplastin time and prothrombin time were measured at I0 rain before opera- tion and 24 h after operation. Results Compared with Han group, the amount of heparin, ratio of prota- mine to heparin for heparin neutralization and requirement for intraoperative blood transfusion were signifi- cantly decreased, the postoperative drainage volume was decreased, activated partial thromboplastin time was shortened at 24 h after operation, the frequency of A/A genotype was increased and the frequency of G/ G genotype was decreased at ATm gene single-nueleotide polymorphism sites rs5877 and rs5878, and the minimum allele （A〉G） frequency was increased in Uighur group （P〈0.05）. Conclusion ATm gene polymorphism may be one of the mechanisms underlying individual variation in anticoagulant effect of hepa-rin between the patients of Uighur nationality and Han nationality.

关 键 词：抗凝血酶Ⅲ 多态性 单核苷酸 肝素 人种群 

分 类 号：R614[医药卫生—麻醉学]