Zhang Jia-Hui, Wang Jing, Tang Xiao-Fang, Yao Yi, Zhang Yin, Ma Yuan-Liang, Xu Bo, Gao Run-Lin, Song Lei, Gao Zhan, Chen Jue, Wu Yuan, Yang Yue-Jin, Meng Xian-Min, Yuan Jin-Qing
a Department of Cardiology, State Key Laboratory of Cardiovascular Disease , Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , People's Republic of China.
Platelets. 2016;27(1):75-9. doi: 10.3109/09537104.2015.1034096. Epub 2015 Apr 22.
Polymorphisms in platelet receptor genes may influence platelet function. This study aimed to assess the impact of five polymorphisms of genes encoding platelet receptors on the risk of ischemic and bleeding events in ST-elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI). 503 consecutive Chinese patients with STEMI after an uneventful PCI and exposed to standard dual antiplatelet therapy for 12 months were enrolled. Polymorphisms of platelet receptors, GPIa (ITGA2, 807C > T, rs1126643), GPVI (GP6, 13254T > C, rs1613662), PAR-1 (F2R, IVS-14A > T, rs168753) and P2Y12 (P2RY12, 34C > T, rs6785930 and H1/H2 haplotype, 52G > T, rs6809699) were detected by the ligase detection reaction. The follow-up period was 12 months. Overall, 34 (6.8%) ischemic events occurred and 46 (9.1%) major bleedings occurred. Multivariate Cox regression analysis showed the carriage of F2R rs168753 minor allele was an independent predictor of the composite ischemic events (HR 0.387, 95% CI 0.193-0.778, p = 0.008) after adjusted for established risk factors. Multivariate logistic regression model identified that carriage of P2RY12 rs6809699 minor allele (OR 2.71, 95% CI 1.298-5.659, p = 0.008) was an independent predictor of major bleedings. The associations were then validated in a second cohort of 483 STEMI patients. In STEMI patients after PCI, F2R rs168753 minor allele could significantly contribute to the risk of ischemic events, and P2RY12 rs6809699 minor allele could predict bleedings. The genetic testing of platelet receptors can be valuable in predicting adverse events in STEMI patients after PCI.
血小板受体基因的多态性可能会影响血小板功能。本研究旨在评估编码血小板受体的五个基因多态性对接受经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者发生缺血性和出血性事件风险的影响。纳入了503例连续的中国STEMI患者，这些患者PCI术后情况平稳，并接受了12个月的标准双联抗血小板治疗。采用连接酶检测反应检测血小板受体GPIa（ITGA2，807C>T，rs1126643）、GPVI（GP6，13254T>C，rs1613662）、PAR-1（F2R，IVS-14A>T，rs168753）和P2Y12（P2RY12，34C>T，rs6785930以及H1/H2单倍型，52G>T，rs6809699）的多态性。随访期为12个月。总体而言，发生了34例（6.8%）缺血性事件和46例（9.1%）大出血事件。多变量Cox回归分析显示，在对既定风险因素进行校正后，携带F2R rs168753次要等位基因是复合缺血性事件的独立预测因素（HR 0.387，95%CI 0.193-0.778，p=0.008）。多变量逻辑回归模型确定，携带P2RY12 rs6809699次要等位基因（OR 2.71，95%CI 1.298-5.659，p=0.008）是大出血的独立预测因素。然后在483例STEMI患者的第二个队列中对这些关联进行了验证。在PCI术后的STEMI患者中，F2R rs168753次要等位基因可显著增加缺血性事件风险，而P2RY12 rs6809699次要等位基因可预测出血情况。血小板受体的基因检测对于预测PCI术后STEMI患者的不良事件可能具有重要价值。
