线粒体乙醛脱氢酶2野生型基因对冠状动脉搭桥患者的心肌保护作用

目的：对在体外循环（CPB）下行冠状动脉搭桥（CABG）手术的成年患者，筛查线粒体乙醛脱氢酶2（ALDH2）野生型基因，观察其对心肌缺血再灌注损伤（I/R）的保护作用。方法：收集择期行CABG的患者48例，根据对ALDH2基因SNP504位点检测结果，分为2组：野生型组（携带ALDH2野生型基因，n=29）和突变型组（携带ALDH2突变型基因，n=19）。收集患者一般资料，采集术后24 h中心静脉血检测心肌肌钙蛋白I（cTnI）、肌红蛋白（Mb）、肌酸激酶同工酶（CK-MB）含量以及丙二醛（MDA）含量。记录术后机械通气时间、术后ICU住院时间和术后24 h变力性药物使用评分。结果：2组患者年龄、性别、体质量、术前左室射血分数、CPB时间、冠脉搭桥数目比较差异无统计学意义（均P＞0.05）。野生型组术后机械通气时间、ICU住院时间少于突变型组（均P＜0.05）。野生型组术后24 h cTnI、Mb、CK-MB含量低于突变型组（均P＜0.05）。野生型组MDA含量低于突变型组（P＜0.05）。野生型组术后24 h变力性药物使用评分低于突变型组（P＜0.01）。结论：对于在CPB下行CABG的患者，携带ALDH2野生型基因能显著降低醛类堆积，减少心肌损伤，缩短术后机械通气时间以及ICU住院时间，对心肌I/R具有保护作用。

Effect of mitochondrial aldehyde dehydrogenase 2 genotype on cardio-protection in patients with coronary artery bypass grafting

Objective: To investigate the clinical effect of ALDH2*1 allele on cardio-protection of patients with coronary artery bypass grafting (CABG). Methods: Forty eight patients undergone simple CABG were divided into 2 group: ALDH2*1 (n=29) and ALDH2*2 (n=19), according to the results of ALDH2 gene SNP504 detection. 24 hours after operation, blood sample were taken for the measurement of cTnI, Mb, CK-MB and MDA. Postoperative mechanical ventilation time, ICU length of stay and postoperative 24 h cardiac drug use score were recorded. Results: There was no difference in the patient’s data among two groups, including age, body weight, ejection fractions and operation time. ALDH2*1 carriers showed lower cTnI, Mb, CK-MB and MDA, and shorter postoperative mechanical ventilation time, ICU length of stay and postoperative 24 h cardiac drug use score. Conclusion: ALDH2*1 allele protects against myocardium injury during open heart surgery cardiopulmonary bypass. The mechanism may be related to ALDH2 enzymes metabolism of toxic aldehydes.