急性ST段抬高型心肌梗死患者Lp-PLA2基因多态性对PCI术后发生不良心脑血管事件的预测价值分析  

Analysis of the Predictive Value of Lp-PLA2 Gene Polymorphism in Patients with Acute ST-Segment Elevation Myocardial Infarction for the Occurrence of Adverse Cardiovascular and Cerebrovascular Events after PCI

作　　者：刘亚东[1] 齐茗 王海晶 马利军[1] 屈晓威[1] 王丽萍 冯莉莉[1] LIU Ya-dong;QI Ming;WANG Hai-jing;MA Li-jun;QU Xiao-wei;WANG Li-ping;FENG Li-li(Cardiovascular and Cerebrovascular Hospital,Affiliated Hospital of Yan’an University,Shaanxi Yan’an 716000,China)

机构地区：[1]延安大学附属医院心脑血管病区,陕西延安716000

出　　处：《现代检验医学杂志》2021年第4期81-86,138,共7页Journal of Modern Laboratory Medicine

基　　金：陕西省教育厅专项科研计划项目(项目编号:20JK0981)。

摘　　要：目的探讨急性ST段抬高型心肌梗死(acute ST-segment elevation myocardial infarction,STEMI)患者脂蛋白相关磷脂酶A2(lipoproteinassociated phospholipase A2,Lp-PLA2)基因多态性对经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后心脑血管不良事件(major adverse cardiac and cerebral vascular events,MACCE)的预测价值。方法选择2018年1月~2019年8月在延安大学附属医院确诊并行PCI术的STEMI患者183例,PCI术前采集静脉血,检测实验室指标及Lp-PLA2基因R92H,V279F和A379V位点基因型,通过电话及门诊等方式随访1年,记录MACCE,根据是否发生MACCE将随访到的患者分为MACCE组和非MACCE组,通过t检验、χ^(2)检验和Kaplan-Meier生存曲线及COX回归分析两组一般资料及Lp-PLA2基因R92H,V279F和A379V基因型的差异。结果随访1年,共随访到168例患者,其中58例患者发生MACCE,占34.52%。MACCE组和非MACCE组Lp-PLA2基因R92H基因频率和等位基因频率差异有统计学意义(χ^(2)=8.602和11.409,均P<0.005)。Lp-PLA2基因R92H位点RR基因型与RH+HH基因型患者MACCE,再次心肌梗死及心脏骤停比例差异有统计学意义(χ^(2)=9.602,4.079和7.348,均P<0.05),Kaplan-Meier生存曲线显示同样的结果(Log Rank检验,χ^(2)=8.373,4.309,8.937,均P<0.05)。COX回归显示Lp-PLA2基因R92H位点为RH+HH基因型的STEMI患者较RR基因型PCI术后发生MACCE风险增加(OR=1.977,95%CI=1.396~3.221,P=0.007)。结论STEMI患者Lp-PLA2基因R92H位点基因多态性与PCI术后发生MACCE风险相关。Objective To investigate the predictive value of Lp-PLA2 gene polymorphisms in patients with acute ST-segment elevation myocardial infarction(STEMI)for adverse cardiovascular and cerebrovascular events after PCI.Methods 183 STEMI patients diagnosed with parallel PCI at the Affiliated Hospital of Yan’an University from January 2018 to August 2019 were selected,venous blood was collected before PCI,laboratory indices and genotypes of Lp-PLA2 gene R92H,V279F and A379V loci were tested,followed up for 1 year by telephone and outpatient,MACCE was recorded,and according to whether.The patients were divided into MACCE and non-MACCE groups according to the occurrence of MACCE.The differences in general data and Lp-PLA2 gene R92H,V279F and A379V genotypes between the two groups were analysed by t-test,χ^(2) test,Kaplan-Meier survival curve and COX regression.Results A total of 168 patients were followed up for 1 year,of whom 58 patients(34.52%)developed MACCE,and the difference in the frequency and allele frequency of the R92H gene of the Lp-PLA2 gene between the MACCE and non-MACCE groups was statistically significant(χ^(2)=8.602 and 11.409,all P<0.005),whith the difference in the percentage of MACCE,recurrent myocardial infarction and cardiac arrest between the Lp-PLA2 gene R92H.There was a statistically significant difference in the proportion of MACCE,repeat myocardial infarction and cardiac arrest between patients with the RR genotype at the locus and the RH+HH genotype(χ^(2)=9.602,4.079 and 7.348,all P<0.05),and Kaplan-Meier survival curves showed the same results(Log Rank test,χ^(2)=8.373,4.309 and 8.937,all P<0.05)COX regression showed an increased risk of MACCE after PCI in STEMI patients with the RH+HH genotype at the R92H locus of the Lp-PLA2 gene compared to the RR genotype(OR=1.977,95%CI=1.396~3.221,P=0.007).Conclusion Genetic polymorphisms at the R92H locus of the Lp-PLA2 gene were associated with the risk of MACCE after PCI in patients with STEMI.

关 键 词：脂蛋白相关磷脂酶A2基因多态性 急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 不良心脑血管事件 

分 类 号：R542.22[医药卫生—心血管疾病] Q786[医药卫生—内科学]