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目的探讨经皮冠状动脉介入术(PCI)后血小板功能变化与血小板膜糖蛋白Ⅰa基因807C/T多态性的关系。方法对佳木斯大学附属第一医院2003—2004年46例行PCI的冠心病患者分别于术前、术后即刻、术后24h肘静脉采血,测定血浆中GMP-140、vWF浓度和PAI-1的活性;应用引物序列特异性聚合酶链反应(PCR-SSP)的方法确定基因型,对不同基因型患者冠脉介入术前、术后血小板功能指标的变化情况进行对比观察。结果血小板膜糖蛋白Ⅰa基因为TC基因型25例(占54.35%),CC基因型21例(占45.65%),无TT基因型。2组患者血浆中GMP-140、vWF含量和PAI-1活性在术前无差异(P>0.05);2组患者血浆中GMP-140含量在术后即刻较术前有显著增高,术后24h有所下降,但仍高于术前,TC组增高程度显著高于CC组(P<0.05);2组患者血浆中vWF含量在术后即刻较术前有增高趋势,但均无显著变化,24h后均有显著增高(P<0.05),2组增高程度无差异。2组患者血浆中PAI-1活性术后即刻较术前有显著增高,术后24h增高更为明显,且TC组增高程度显著高于CC组(P<0.01)。结论血小板GPⅠa基因TC基因型患者在PCI术后较CC基因型患者存在更加显著的血小板活化和纤溶功能的改变,提示血小板GPⅠaT等位基因可能是经皮冠状动脉介入术后急性与亚急性冠状动脉血栓形成的一个危险因素。
Objective To investigate the relationship between platelet function and platelet membrane glycoprotein Ⅰ a gene 807C / T polymorphism after percutaneous coronary intervention (PCI). Methods 46 patients with coronary artery disease undergoing PCI at the First Affiliated Hospital of Jiamusi University from 2003 to 2004 were collected at the antecubital vein 24h before surgery, immediately after surgery, and the plasma concentrations of GMP-140, vWF and PAI-1 The genotypes were determined by polymerase chain reaction-specific polymerase chain reaction (PCR-SSP). The changes of platelet function indexes before and after coronary intervention in different genotypes were compared. Results There were 25 cases (54.35%) of TC genotypes and 21 cases (45.65%) of CC genotypes in platelet membrane glycoprotein Ia gene. There was no TT genotype. There was no difference in plasma GMP-140, vWF and PAI-1 activity between the two groups before operation (P> 0.05). Plasma GMP-140 levels in two groups were significantly higher than those before operation immediately after operation (P <0.05). The content of vWF in plasma of the two groups had a trend of increasing immediately after the operation compared with that before operation, but there was no significant change in the level of vWF in the two groups. 24h after treatment were significantly increased (P <0.05), no difference between the two groups increased. The plasma PAI-1 activity in group 2 was significantly higher than that before operation, and increased significantly at 24 hours after operation. The level of PAI-1 in TC group was significantly higher than that in CC group (P <0.01). Conclusion Platelet GPⅠa gene TC genotype patients had more significant changes in platelet activation and fibrinolytic function after PCI than those with CC genotype, suggesting that the platelet GPⅠaT allele may be the acute and subacute coronary artery after percutaneous coronary intervention A risk factor for arterial thrombosis.