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目的:探讨PON1(rs662)基因多态性对冠脉介入治疗患者血小板高反应性的影响。方法:279例PCI术后患者,给予氯吡格雷75 mg·d-1及阿司匹林100 mg·d-1抗血小板治疗,服用5 d后空腹抽取静脉血,并检测血栓弹力图(TEG)。将氯吡格雷治疗后血小板高反应性(HPR)定义为二磷酸腺苷(ADP)诱导的血小板抑制率<50%。应用单因素和多因素回归分析PON1(rs662)基因多态性及临床因素对HPR的影响,利用受试者工作曲线(ROC curve)检验联合独立风险因素模型预测HPR的效力。结果:279例PCI术后患者HPR发生率为19.0%。多因素logistic回归分析示PON1(rs662)A等位基因(OR=2.101,95%CI=1.002~4.406,P=0.049)、糖尿病(OR=1.921,95%CI=1.023~3.604,P=0.042)为HPR的独立风险因素。联合独立风险因素模型预测HPR的曲线下面积(AUC)为0.680(95%CI=0.600~0.760,P<0.001)。结论:PON1(rs662)A等位基因及糖尿病为PCI术后患者HPR的独立危险因素。通过联合独立风险因素模型预测HPR的效力良好。
Objective: To investigate the effect of PON1 (rs662) gene polymorphism on platelet hyperreactivity in patients undergoing coronary intervention. Methods: Two hundred and seventy-seven patients with PCI were given anti-platelet therapy with clopidogrel 75 mg · d-1 and aspirin 100 mg · d-1. After 5 d, venous blood was drawn from the abdomen and the thromboelastogram (TEG) was measured. Platelet reactivity (HPR) after clopidogrel treatment was defined as adenosine diphosphate (ADP) -induced platelet inhibition <50%. Univariate and multivariate regression analysis of PON1 (rs662) gene polymorphisms and clinical factors on the impact of HPR, the use of receiver operating curve (ROC curve) test combined with independent risk factors to predict the effectiveness of HPR. Results: The incidence of HPR in 279 patients after PCI was 19.0%. Multivariate logistic regression analysis showed that the PON1 (rs662) A allele (OR = 2.101,95% CI = 1.002-4.406, P = 0.049) and diabetes mellitus (OR = 1.921,95% CI 1.023-3.604, P = 0.042) Is an independent risk factor for HPR. The area under the curve (AUC) predicted by the combined independent risk factors model was 0.680 (95% CI = 0.600-0.760, P <0.001). Conclusion: PON1 (rs662) A allele and diabetes are independent risk factors for HPR in patients after PCI. The efficacy of HPR is predicted by a joint independent risk factor model.