中国汉族冠心病患者药物洗脱支架置入术后内皮型一氧化氮合酶基因T786C多态性与支架内再狭窄的关系
Association of the Endothelial Nitric Oxide Synthase Gene T786C Polymorphism with In-Stent Restenosis in Chinese Han Patients with Coronary Artery Disease Treated with Drug-Eluting Stent.
作者信息
Zeng Wen-Ping, Zhang Rui, Li Ran, Luo Jin-Fang, Hu Xiao-Feng
机构信息
Department of Cardiology, Zhejiang Hospital, Hangzhou, Zhejiang Province, China.
Department of Cardiology, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi Province, China.
出版信息
PLoS One. 2017 Jan 27;12(1):e0170964. doi: 10.1371/journal.pone.0170964. eCollection 2017.
BACKGROUND AND AIM
Many studies have reported that genetic variants correlate with higher risk for coronary artery disease (CAD) or in-stent restenosis (ISR) after bare metal stent (BMS) implantation. However, there is limited data assessing the impact of these variants on ISR in patients treated with drug-eluting stent (DES). The purpose of this study was to investigate the effects of genetic risk factors on ISR in Chinese Han patients treated with DES.
METHODS
A total of 425 patients with a diagnosis of CAD who underwent successful revascularization in native coronary arteries with DES were included in this retrospective study. Genotyping was performed on six single nucleotide polymorphisms (SNPs) in the endothelial nitric oxide synthase gene (eNOS), the angiotensin converting enzyme gene (ACE), the angiotensin II type 1 receptor gene (AT1R), the transforming growth factor beta gene (TGF-β), and the vascular endothelial growth factor gene (VEGF). Quantitative coronary angiography (QCA) was performed during the follow-up period to detect ISR. Logistic regression models were used to test for association.
RESULTS
Fifty-four patients (12.7%) developed ISR during the follow-up period. Of the six analyzed SNPs, the frequency of the C allele of T786C polymorphism in eNOS was significantly higher in the ISR group (22.2%) compared to the non-ISR group (12.7%) (p<0.01). In the ISR group, the frequency of the TT, TC, and CC genotypes was 61.1%, 33.3%, and 5.6%, respectively, and in the non-ISR group, the frequencies were 76.8%, 21.0%, and 2.2%, respectively. The multivariable analysis adjusted for potential confounders and revealed that the T786C polymorphism increased the risk of ISR in both additive and dominant models with odds ratios of 1.870 (95% confidence interval [CI]: 1.079-3.240, p = 0.03) and 2.045 (95% CI: 1.056-3.958, p = 0.03), respectively.
CONCLUSION
The eNOS T786C polymorphism was associated with ISR in Chinese Han patients treated with DES. Genotyping may be helpful to identify patients with higher risks of ISR after DES implantation.
背景与目的
许多研究报告称，基因变异与冠状动脉疾病（CAD）风险升高或裸金属支架（BMS）植入后支架内再狭窄（ISR）风险升高相关。然而，评估这些变异对接受药物洗脱支架（DES）治疗患者ISR影响的数据有限。本研究的目的是调查基因危险因素对接受DES治疗的中国汉族患者ISR的影响。
方法
本回顾性研究纳入了425例诊断为CAD且在原生冠状动脉中成功接受DES血管重建的患者。对内皮型一氧化氮合酶基因（eNOS）、血管紧张素转换酶基因（ACE）、血管紧张素II 1型受体基因（AT1R）、转化生长因子β基因（TGF-β）和血管内皮生长因子基因（VEGF）中的六个单核苷酸多态性（SNP）进行基因分型。随访期间进行定量冠状动脉造影（QCA）以检测ISR。使用逻辑回归模型检验关联性。
结果
54例患者（12.7%）在随访期间发生了ISR。在分析的六个SNP中，与非ISR组（12.7%）相比，eNOS中T786C多态性的C等位基因频率在ISR组中显著更高（22.2%）（p<0.01）。在ISR组中，TT、TC和CC基因型的频率分别为61.1%、33.3%和5.6%，在非ISR组中，频率分别为76.8%、21.0%和2.2%。对潜在混杂因素进行调整的多变量分析显示，T786C多态性在相加模型和显性模型中均增加了ISR风险，比值比分别为1.870（95%置信区间[CI]：1.079 - 3.240，p = 0.03）和2.045（95% CI：1.056 - 3.958，p = 0.03）。
结论
eNOS T786C多态性与接受DES治疗的中国汉族患者的ISR相关。基因分型可能有助于识别DES植入后ISR风险较高的患者。
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