基于ACE基因多态性探讨冠心病患者支架术后心血管事件发生风险  

Risk exploration of cardiovascular events after coronary stent implantation in patients with coronary heart disease:a study based on ACE gene polymorphisms

作　　者：王璐璐 罗婷 张盈盈 WANG Lu-lu;LUO Ting;ZHANG Ying-ying(Department of Cardiology,Wuhan Hospital of Integrated Traditional Chinese and Western Medicine&Wuhan First Hospital&Hospital of Integrated Traditional Chinese and Western Medicine,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,Hubei,China)

机构地区：[1]武汉市中西医结合医院、武汉市第一医院、华中科技大学同济医学院附属中西医结合医院心内科,湖北武汉430022

出　　处：《心脏杂志》2024年第6期633-637,共5页Chinese Heart Journal

基　　金：湖北省中医药科研项目(ZY2021Q01)。

摘　　要：目的探讨血管紧张素I转换酶(ACE)基因插入/缺失(I/D)基因多态性与冠心病患者支架术后心血管事件发生风险的关系。方法本研究为2021年1月~2022年3月在武汉市中西医结合医院进行的单中心队列研究。对象为接受急诊或择期冠状动脉支架植入术的冠心病患者,并在植入后使用氯吡格雷和阿司匹林双重抗血小板治疗,持续至少1年。对患者随访12个月。使用TaqMan分析对ACE I/D进行基因分型。通过光透射聚集测定法评估血小板聚集。主要不良心血管事件(MACE)定义为心血管死亡、心肌梗死和缺血性卒中的复合事件。结果在随访期间,共有44例患者出现MACE,包括15例心源性死亡、16例非致死性心肌梗死和13例缺血性卒中。与未发生MACE的患者相比,发生MACE的患者年龄更大,左心室射血分数降低比例更高,诊断为稳定型心绞痛例数更少和ST段抬高急性心肌梗死例数更多(均P<0.01)。与无MACE组相比,MACE组II基因型与DD基因型比例低,ID基因型+DD基因型比例高(均P<0.05)。进行COX回归分析,模型根据临床协变量进行了调整,调整模型包括年龄、既往心肌梗死、高血压、糖尿病、左心室射血分数、血清肌酐、诊断、低密度脂蛋白、吸烟状况和既往经皮冠状动脉介入治疗。各类型基因型比较,ID或DD基因型患者的MACE风险是II基因型患者的1.99倍(调整模型中校正HR:1.99,95%CI:1.00~3.98,P<0.05)。ID基因型患者发生MACE的风险是II基因型患者的2.13倍(调整模型中校正HR:2.13;95%CI:1.10~4.12,P<0.05),而DD和II基因型之间的MACE风险无显著差异。与II基因型相比,基线的和1个月的ID或DD基因型患者血小板反应性百分数值升高;与ID基因型相比,基线的和1个月的DD基因型患者血小板反应性百分数值升高,均P<0.01。结论ACE I/D基因多态性(rs4646994)中ID基因型与PCI支架植入术后患者1年随访时心血管风险增加相关,ID或DD与血小板反应�AIM To investigate the relationship between the insertion/deletion(I/D)polymorphism of angiotensin I converting enzyme(ACE)gene and the risk of cardiovascular events in patients with coronary heart disease after stent implantation.METHODS This was a single-center cohort study conducted in our hospital from January 2021 to March 2022. The inclusion criteria were patients withcoronary heart disease who received emergency or elective coronary stent implantation and were treatedwith clopidogrel 75 mg and aspirin 100mg once a day for at least one year after implantation. The patientswere followed up for 12 months. ACE I/D was genotyped by TaqMan analysis and platelet aggregationwas evaluated by light transmission aggregation assay. Major cardiovascular adverse events (MACE)were defined as compound events of cardiovascular death, myocardial infarction and ischemic stroke.RESULTS During the follow-up period, a total of 44 patients experienced MACE, including 15 casesof cardiac death, 16 cases of non fatal myocardial infarction, and 13 cases of ischemic stroke. Comparedwith patients who did not experience MACE, patients who experienced MACE were older, had morecases of decreased left ventricular ejection fraction, fewer cases of diagnosed stable angina, and morecases of ST segment elevation acute myocardial infarction (all P<0.01). Compared with the non MACEgroup, the MACE group had a lower proportion of genotype II and DD, and a higher proportion ofgenotype ID and DD (both P<0.05). Cox regression analysis was conducted, and the model was adjustedaccording to clinical covariates, including age, previous myocardial infarction, hypertension, diabetes,left ventricular ejection fraction, serum creatinine, diagnosis, low-density lipoprotein, smoking status, andprevious percutaneous coronary intervention. The MACE risk of patients with ID or DD genotype is 1.99times higher than that of patients with II genotype compared to different genotypes (adjusted for HR:1.99, 95% CI: 1.00~3.98, P<0.05). The risk of MACE in patients with

关 键 词：血管紧张素I转换酶 冠心病 冠状动脉支架植入术 主要不良心血管事件 基因多态性 

分 类 号：R541.4[医药卫生—心血管疾病]