非体外循环冠状动脉旁路移植术后的多态性和高阿司匹林血小板反应性。
Polymorphisms and high on-aspirin platelet reactivity after off-pump coronary artery bypass grafting.
机构信息
Department of Cardiovascular Surgery, Tianjin Medical University General Hospital, Tianjin, P. R. China.
出版信息
Scand Cardiovasc J. 2013 Aug;47(4):194-9. doi: 10.3109/14017431.2013.800640. Epub 2013 May 31.
OBJECTIVES
High on-aspirin residual platelet reactivity (RPR) after coronary artery bypass grafting (CABG) is a transient phenomenon with important implications for graft patency. This study was designed to determine the role of polymorphisms [TBXA2R (T924C), GPIIIa (Pl(A1/A2)), P2Y1 (A1622G), and GP1Bα (C1018T)] on RPR in Chinese patients undergoing off-pump CABG (OPCAB).
METHODS
Of 420 patients recruited to this study, 210 patients underwent primary OPCAB and 210 controls with ischemic heart disease received optimal medical therapy. Arachidonic acid-induced platelet aggregation and urinary 11-dehydro thromboxane B2 were measured at baseline and following aspirin administration on days 1, 4, 10, and on 6th month. Four polymorphisms were identified [TBXA2R (T924C), P2Y1 (A1622G), Pl(A1/A2) and GP1Bα (C1018T)].
RESULTS
On the first post-operative day, 62 patients (29.5%) were with high RPR and 148 (70.5%) were with low RPR. Of the former, 33 (15.7%), 10 (4.6%), and 0 (0%) patients remained with high RPR on days 4, 10, and on 6 month, respectively. No individuals with high RPR was found in controls. Logistic regression identified TBXA2R-924TT (OR = 4.5; 95% CI, 1.8-11.1) and body mass index > 27 kg/m(2) (OR = 2.73; 95% CI, 1.1-7.0) as independent risk factors for high on-aspirin RPR.
CONCLUSIONS
High on-aspirin RPR after OPCAB is associated with genetic polymorphism TBXA2R-924TT and obesity.
目的
经皮冠状动脉旁路移植术后高阿司匹林残余血小板反应性（RPR）是一种短暂现象，对移植物通畅性有重要影响。本研究旨在确定中国行非体外循环冠状动脉旁路移植术（OPCAB）患者中多态性[血栓烷 A2 受体（T924C）、血小板膜糖蛋白 IIIa（Pl（A1/A2））、P2Y1（A1622G）和血小板膜糖蛋白 Ibα（C1018T）]对 RPR 的作用。
方法
本研究共纳入 420 例患者，其中 210 例行 OPCAB，210 例冠心病患者接受最佳药物治疗。在基线及阿司匹林治疗第 1、4、10 天及第 6 个月时，测定花生四烯酸诱导的血小板聚集和尿 11-脱氢血栓烷 B2。共发现 4 种多态性[血栓烷 A2 受体（T924C）、P2Y1（A1622G）、Pl（A1/A2）和血小板膜糖蛋白 Ibα（C1018T）]。
结果
术后第 1 天，62 例（29.5%）患者存在高 RPR，148 例（70.5%）患者存在低 RPR。其中，33 例（15.7%）、10 例（4.6%）和 0 例（0%）患者分别在第 4、10 天及第 6 个月时仍存在高 RPR。对照组未发现高 RPR 患者。Logistic 回归分析发现，血栓烷 A2 受体-924TT（OR=4.5；95%CI，1.8-11.1）和体重指数>27kg/m2（OR=2.73；95%CI，1.1-7.0）是高阿司匹林残余 RPR 的独立危险因素。
结论
OPCAB 术后高阿司匹林 RPR 与血栓烷 A2 受体-924TT 多态性和肥胖有关。
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