内皮一氧化氮合酶基因G894T多态性与动脉瘤性蛛网膜下腔出血的相关性研究

目的 研究eNOS基因第7外显子G894T多态性与动脉瘤性蛛网膜下腔出血(aSAH)的相关性.方法 利用聚合酶链反应(PCR)、琼脂糖凝胶电泳验证PCR反应产物,限制性片段长度多态性(RFLP)分析比较aSAH患者和对照者eNOS基因型的构成及等位基因频率的分布.结果 aSAH患者组的GT+TT基因型和T等位基因频率显著高于对照组,差异具有统计学意义.基因型分布在破裂的颅内动脉瘤直径大小之间差异无统计学意义,但是与aSAH患者预后相关.结论 eNOS基因G894T多态性可能是asAH发病的危险因子之一,GT+TT基因型与不良预后密切相关.     

精神分裂症患者一级亲属的探索性眼球运动与eNOS基因G894T多态性研究

目的：探讨内皮型一氧化氮合成酶（eNOS）基因G894T多态性与精神分裂症患者一级亲属探索性眼球运动（EEM）缺陷的相关性。方法：共收集精神分裂症患者一级亲属193名,正常对照家系一级亲属150名,进行EEM检查,并采用基因芯片技术进行eNOS基因型检测。结果：精神分裂症一级亲属EEM异常率（52%）显著高于正常对照家系一级亲属EEM异常率（15%）（χ^2=52,P〈0.01）;EEM异常者与EEM正常者eNOS基因GT＋TT基因型频率及T等位基因频率差异无显著性（χ^2=2.08,P〉0.05;χ^2=2.55,P〉0.05）。在101名精神分裂症一级亲属的EEM异常者中,对30名GT＋TT基因型携带者与71名GG基因型携带者的凝视点数（NEF）、反应性探索评分（RSS）比较,差异均无显著性（P均〉0.05）。结论：eNOS基因G894T多态性与精神分裂症患者一级亲属的EEM缺陷可能无关。     

Association between Endothelial nitric oxide synthase G894T gene polymorphism and risk of ischemic stroke in North Indian population: a case-control study

Background and purpose: Stroke is a multi-factorial disease influenced by both genetic and environmental factors. The aim of this case-control study was to determine the association between Endothelial Nitric Oxide Synthase G894T (rs1799983) gene polymorphism and susceptibility to ischemic stroke (IS) in North Indian population.

Methods: In this present case-control study, genotyping was performed by using Polymerase chain reaction – Restriction fragment length polymorphism (PCR-RFLP) method for 250 IS patients and 250 age and sex matched controls. PCR results were confirmed by DNA sequencing. Frequency distribution of genotypes and alleles were compared between cases and controls using conditional logistic regression.

Results: Hypertension, Diabetes, Dyslipidemia, Low Socioeconomic Status and Family History of Stroke were found to be independent risk factors for IS. Mean age of cases and controls were 52.83 ± 12.59 and 50.97 ± 12.70 years. Multivariate logistic regression analysis showed a significant association between eNOS G894T (rs1799983) polymorphism and risk of IS [OR = 1.57; 95%CI 1.05–2.37; p = 0.028] under dominant model. Based on Trial of Org 10172 in Acute Stroke Treatment classification, an independent association of large vessel disease (LVD) was observed with the risk of IS under the dominant [OR = 2.09; 95% CI 1.17–3.75; p = 0.01] and recessive [4.09 95% CI 1.06–15.68; p = 0.04] models. All the observed genotype frequencies were in accordance with the Hardy–Weinberg equilibrium (HWE) in both cases and controls.

Conclusion: The findings of the present study suggest that polymorphism in G894T position of eNOS gene might be a risk factor for IS mainly for LVD stroke subtype in North Indian population. Further large prospective studies are required to confirm these findings.     

Influence of endothelial nitric oxide synthase gene polymorphisms (-786T>C, 4a4b, 894G>T) in Korean patients with coronary artery disease

INTRODUCTION: Endothelium-derived nitric oxide (NO) is synthesized from l-arginine by endothelial nitric oxide synthase (eNOS) encoded by the eNOS3 gene on chromosome 7. The effects of the eNOS polymorphisms with the risk of coronary artery disease are conflicting. In this study, we investigated the association of the eNOS genotypes with coronary artery disease in Koreans. MATERIALS AND METHODS: A case-control study was performed to evaluate the association between the eNOS -786T>C, 4a4b, or 894G>T polymorphism and coronary artery disease. 147 consecutive patients with coronary artery disease and 222 healthy controls were recruited. The genotypes of eNOS -786T>C and 894G>T polymorphisms were determined by the polymerase chain reaction-restriction fragment length polymorphism analysis. The genotypes of a 27 bp insertion/deletion in intron 4 (eNOS 4a4b) were determined by the banding pattern on gel electrophoresis. RESULTS: The eNOS -786T>C (odds ratio [OR]; 1.61, 95% confidence interval [CI]; 0.97-2.69), 894G>T (OR; 1.12, 95% CI; 0.65-1.92) and 4a4b (OR; 1.44, 95% CI; 0.87-2.39) polymorphisms were not an independent predisposition factor to coronary artery disease. However, a subgroup analysis adjusted with various cardiovascular risk factors confirmed positive association of the -786T>C polymorphism in CAD patients with hypertension and a smoking history and also a significant association of the intron 4 genotypes with a smoking history, but no significance has been found in the eNOS polymorphisms of 894G>T upon any risk adjustment. In this study we also found that the distribution of heterozygotes (-786TC, 894GT, and 4a4b) and variant homozygotes for the -786C, 894T, and intron 4a alleles of eNOS in Koreans were significantly lower than in Caucasian populations. CONCLUSIONS: The present study demonstrates that polymorphisms of the eNOS -786T>C and 4a4b are associated with coronary artery disease with adjustments for cardiovascular risk factors in the Koreans.     

中国人内皮型一氧化氮合酶基因G894T多态性与脑梗死相关性的Meta分析

目的综合评价中国人内皮型一氧化氮合酶基因G894T(Glu298Asp)多态性与脑梗死的关系。方法搜集国内外公开发表的有关中国人内皮型一氧化氮合酶基因G894T多态性与脑梗死关系的研究文献,剔除不符合要求的文献,应用Meta分析软件RevMan5.1,对各研究结果进行异质性检验及数据合并,应用RevMan5.1和Stata11.0评估发表偏倚。结果共有11篇文献纳入Meta分析,累计病例组1768例,对照组1818例。合并基因型(GT+TT)/GG的OR值为1.46,95%CI为1.24～1.73(P<0.00001),合并基因型TT/GG的OR值为2.18,95%CI为1.32～3.61(P=0.002),合并基因型GT/GG的OR值为1.41,95%CI 1.18～1.67(P=0.0001),合并等位基因T/G的OR值为1.65,95%CI 1.28～2.12(P=0.0001)。结论中国人内皮型一氧化氮合酶基因G894T(Glu298Asp)多态性与脑梗死的发病具有相关性。携带基因型TT、GT及等位基因T可增加患脑梗死的风险。     

内皮源性一氧化氮合酶基因多态性与缺血性脑卒中相关性研究

目的通过病例对照研究,探讨内皮源性一氧化氮合酶(eNOS)基因多态性与缺血性脑卒中的关系。方法采用聚合酶链反应(PCR)和限制性片断长度多态性(RFLP)技术,对452例缺血性脑卒中患者和153例健康对照人群的eNOS基因rs3918181位点进行基因多态性检测。结果大动脉粥样硬化型脑梗死组的基因型与等位基因频率与正常对照组比较P>0.05,无统计学意义。腔隙性脑梗死组eNOS基因AA AG基因型频率明显高于对照组,相对于GG基因型,暴露于AA AG基因型人群的OR值为1.644(95%CI 1.124～2.405)。腔隙性脑梗死A等位基因频率也显著高于对照组,相对于G等位基因,A等位基因OR值为1.419(95%CI 1.061～1.898)。结论内皮源性一氧化氮合酶(e-NOS)基因rs3918181位点多态性与腔隙性脑梗死相关;A等位基因可能增加中国汉族人罹患腔隙性脑梗死的风险。     

内皮型一氧化氮合酶基因第4内含子基因多态与福建汉族脑血管病的相关性

目的 研究福建汉族人内皮型一氧化氮合酶(endothelial nitric oxide synthase,eNOS)基因第4内含子27 bp可变串联重复序列(variable number of tandem repeat,VNTR)与脑血管病关系.方法 依据缺血性卒中TOAST(Trial of ORG 10172 in Acute Stroke Treatment)分型收集132例大动脉粥样硬化性卒中(large artery atherosclerosis,LAA),63例腔隙性脑梗死(lacunar infarction,LI)及62例高血压性脑出血患者为病例组,同时选择年龄、性别匹配的237名健康者为对照组,采用聚合酶链反应结合2%琼脂糖电泳技术检测eNOS基因第4号内含子27 bp VNTR的多态性.结果 正常福建汉族人eNOS基因第4内含子除bb,ab,aa基因型外,尚出现罕见的bc基因型,其基因型频率分别为0.789,0.203,0.004,0.004;b、a、c等位基因频率分别为.892,0.106及0.002.LAA及LI患者27 bp VNTR多态与对照组差别无统计学意义,LAA组bc基因型频率(0.030)虽明显高于对照组(0.004),但差异无统计学意义;缺血性卒中伴/不伴高血压病与该基因多态无相关性.高血压性脑出血患者的aa基因型频率为0.048.明显高于bb+ab基因型(OR=11.42,95% CI:1.209-117.892,P<0.05).结论 eNOS第4内含子aa基因型可能是福建汉族人高血压性脑出血的遗传危险因素,但该位点多态性与福建汉族LAA及LI无相关性.     

The G894T polymorphism on endothelial nitric oxide synthase gene is associated with increased coronary heart disease among Asia population: evidence from a Meta analysis

Introduction

Growing studies have revealed the underlying association between eNOS 894 G/T (rs1799983) polymorphism and coronary heart disease (CHD) among Asia population. Results from these studies remained conflicting. We conducted this meta-analysis to estimate the overall CHD risk of eNOS 894 G/T polymorphism regarding Asia population.

Materials and methods

Up to October 2011, databases including PubMed, Embase and CNKI (China National Knowledge Infrastructure) were searched to access the relevant genetic association studies. Summary odds ratios and corresponding 95% confidence intervals (CIs) for eNOS 894 G/T polymorphism and CHD risk were estimated using fixed or random-effects models when appropriate.

Results

18 case-control studies with 2,994 cases and 3,130 controls were available for this study, including 13 studies of East-Asia descendents, 5 studies of Non East-Asian descendents. The mean T allele frequency was 0.111 in the East-Asia population and 0.147 in the Non East-Asia population, respectively. The summary OR for CHD associated with the T allele was 1.52 (95% confidence intervals (95%CI), 1.37-1.69) by random effects model. Similarly, significantly increased risks were observed in the East-Asia population (OR = 1.54; 95%CI = 1.35-1.76) and in the Non East-Asia population (OR = 1.48; 95%CI = 1.24-1.77), respectively.

Conclusions

This meta-analysis indicated that eNOS 894 G/T polymorphism may play an important role in CHD development among Asia population.     

内皮细胞性一氧化氮合酶基因可变性重复序列多态性与脑梗死的关系

目的　探讨内皮细胞性一氧化氮合酶 (eNOS)基因内含子 4可变性重复序列 (VNTR)的多态性与脑梗死 (CI)的关系。方法　应用聚合酶链反应 (PCR)技术 ,检测 15 2例CI患者的基因型 ,并与对照组比较。应用多元回归分析进行风险因素独立性分析。结果　CI组eNOS基因ab基因型的频率 (2 2 .36 % )明显高于对照组 (12 .2 8% ) ,a等位基因的频率 (12 .5 % )也明显高于对照组 (7.0 % ) ,差异均有显著性 (均P <0 0 5 )。ab基因型较bb基因型对CI的OR为 2 .0 5 (P <0 0 5 ) ,在用多元回归分析校正其他危险因素后OR为 1.98(P <0 0 5 ) ;CI组患者患高血压、高血脂、糖尿病及吸烟的比例较对照组为高 (均P <0 0 1) ,CI组患者年龄也较对照组高 (P <0 0 5 )。结论　eNOS基因ab基因型与CI有相关性 ,等位基因a可能是CI的独立危险因素。     

内皮型一氧化氮合酶基因+894G/T多态性与偏头痛发病的meta分析

目的分析内皮型一氧化氮合酶(endothelial nitric oxide synthase,eNOS)基因+894G/T多态性与偏头痛发病风险之间的相关性。方法本研究检索时间从建库至2016年10月。纳入评估eNOS多态性(+894G/T)与偏头痛发病风险之间相关性的病例对照研究。初筛得到365篇全文,经筛选后最终5篇纳入meta分析。异质性分析采用I~2检验,文献质量评估采用英国牛津循证医学中心文献严格评价项目。结果与GG+GT基因型相比,TT基因型增加有先兆偏头痛(migraine with aura,MA)的发生风险(OR=1.56,95%CI 1.11~2.20;I~2=0%,P=0.01)。在非高加索人群中,GT+TT基因型可增加偏头痛发病风险(OR=1.53,95%CI 1.08~2.16;I~2=0%,P=0.02)。结论本研究提示内皮型一氧化氮合酶基因+894G/T多态性与偏头痛发病风险之间有一定的关系,并且可能因人群遗传背景的不同与偏头痛亚型有一定关联。     

河南汉族人群eNOS基因VNTR多态性与缺血性脑血管病的关系

目的 探讨河南汉族人群内皮细胞性一氧化氮合酶(eNOS)基因内含子4可变性重复序列(VN-TR)的多态性与缺血性脑血管病(ICVD)的关系.方法 应用聚合酶链反应(PCR)技术,检测488例缺血性脑血管病患者的基因型,并与对照组比较.结果 缺血性脑血管病组eNOS基因ab基因型的频率(18.4%)明显高于对照组(13.57%),a等位基因的频率(11.5%)也明显高于对照组(7.7%),差异均有显著性(P＜0.05).结论 eNOS基因ab基因型与缺血性脑血管病有相关性,等位基因a可能是缺血性脑血管病的危险因素.     

Incidence and risk factors associated with in-hospital venous thromboembolism after aneurysmal subarachnoid hemorrhage

Our purpose was to determine the incidence and risk factors associated with in-hospital venous thromboembolism (VTE) in patients with aneurysmal subarachnoid hemorrhage (aSAH). The Nationwide Inpatient Sample database was queried from 2002 to 2010 for hospital admissions for subarachnoid hemorrhage or intracerebral hemorrhage and either aneurysm clipping or coiling. Exclusion criteria were age <18, arteriovenous malformation/fistula diagnosis or repair, or radiosurgery. Primary outcome was VTE (deep vein thrombosis [DVT] or pulmonary embolus [PE]). Multivariate logistic regression was used to assess association between risk factors and VTE. Secondary outcomes were in-hospital mortality, discharge disposition, length of stay and hospital charges. A total of 15,968 hospital admissions were included. Overall rates of VTE (DVT or PE), DVT, and PE were 4.4%, 3.5%, and 1.2%, respectively. On multivariate analysis, the following factors were associated with increased VTE risk: increasing age, black race, male sex, teaching hospital, congestive heart failure, coagulopathy, neurologic disorders, paralysis, fluid and electrolyte disorders, obesity, and weight loss. Patients that underwent clipping versus coiling had similar VTE rates. VTE was associated with pulmonary/cardiac complication (odds ratio [OR] 2.8), infectious complication (OR 2.8), ventriculostomy (OR 1.8), and vasospasm (OR 1.3). Patients with VTE experienced increased non-routine discharge (OR 3.3), and had nearly double the mean length of stay (p < 0.001) and total inflation-adjusted hospital charges (p < 0.001). To our knowledge, this is the largest study evaluating the incidence and risk factors associated with the development of VTE after aSAH. The presence of one or more of these factors may necessitate more aggressive VTE prophylaxis.     

Treatment patterns of venous thromboembolism in a real-world population: The Q-VTE study cohort

Background

Few studies have assessed treatment patterns of acute venous thromboembolism (VTE) in a real-world population. We aimed to describe anticoagulant treatment patterns for acute VTE using healthcare databases of Québec, Canada.

Methods

We used linked healthcare databases of the province of Québec, Canada to identify all incident cases of deep vein thrombosis (DVT) and pulmonary embolism (PE) between 2000 and 2009. We formed two patient cohorts, one with definite cases (definite VTE cohort, N = 40,776) and the other including cases with definite or probable VTE (any VTE cohort, N = 54,803) that were followed until death, end of health coverage, or end of study (December 31, 2009).

Results

In the definite cohort, 73.6% of subjects were dispensed an anticoagulant following the diagnosis of VTE. Of those who were dispensed a vitamin K antagonist (VKA), median duration of use was 61 days (interquartile range 89). VKA initiation was more likely in patients with pulmonary embolism than deep vein thrombosis alone (HR 1.62, 95% CI (1.58-1.66)). Among outpatients, those managed initially in the outpatient setting were less likely to initiate VKA therapy (HR 0.75, 95% CI (0.68-0.77)), while those requiring admission to hospital for VTE management were more likely to initiate (HR 1.81, 95% CI (1.76-1.87)). Findings were similar in the any VTE cohort.

Conclusion

Our study describes VTE treatment patterns in a real-world setting and suggests that there may be important gaps. These may include significant numbers of patients who did not initiate oral anticoagulant therapy, particularly in the outpatient setting, and shorter duration of oral anticoagulant use than recommended.     

诱导型一氧化氮合酶基因多态与脑卒中合并冠心病

目的 探讨诱导型一氧化氮合酶(NOS)2A基因多态与脑卒中合并冠心病发病的关系.方法 以rs28944190位点为遗传标记,采用聚合酶链反应(PCR)和限制性片段长度多态性(RFLP)检测708例脑卒中患者和235名对照组人群NOS2A基因的多态性.结果 脑卒中组和对照组的rs28944190位点等位基因、基因型频率差异无统计学意义;以是否合并冠心病对病例组人群进行分层后,cocaphase分析表明合并冠心病的脑卒中组rs28944190位点的C等位基因频率(23.9%)较单纯脑卒中组(16.6%)明显增高(x2=5.629,P=0.018,OR=1.580,95%CI 1.083～2.306),这种差异在男性患者更加明显(x2=8.592,P=0.003,OR=1.983,95%CI 1.255～3.134).卡方检验表明合并冠心病的脑卒中组AC+CC基因型的频率(47.9%)明显高于单纯脑卒中组(30.8%,x2=10.761,P=0.001,OR=2.065,95%CI 1.34～3.19),在男性患者差异更加明显(x2=15.762,P=0.000,OR=2.985,95%CI 1.74～5.12).结论 NOS2A基因与脑卒中的发病可能无关,但可能与合并冠心病的脑卒中发病相关.     

Association analysis of a neural nitric oxide synthase gene polymorphism and antipsychotics-induced tardive dyskinesia in Chinese schizophrenic patients

Summary. Recent findings from rodent studies with chronic administration of antipsychotic drugs have indicated the role of neural nitric oxide synthase (NOS1) on the susceptibility of tardive dyskinesia (TD). In the present study, the association between a 3-untranslated region C267T (3-UTR C267T) polymorphism of the NOS1 gene and TD as well as TD severity was investigated in 251 Chinese schizophrenic patients with long-term antipsychotic treatment (TD: 128, non-TD: 123). After adjusting the effects of confounding factors, there was no significant association between NOS1 3-UTR C276T genotypes and TD occurrence (p=0.758). With in the TD group, we could not discover a significant correlation between NOS1 3-UTR C276T genotypes and the scores of abnormal involuntary movement scale (AIMS) (p=0.219 and 0.774). We concluded that the NOS1 3-UTR C276T polymorphism might not play a major role in the susceptibility of TD development, or on the severity of TD.     

The role of soluble P selectin in the diagnosis of venous thromboembolism

Introduction

Soluble P selectin (sPsel), a member of the selectin family of cell adhesion receptors, has been proposed as a key molecule in hemostasis and thrombosis mediating platelet rolling, generating procoagulant microparticles and enhancing fibrin deposition. The aim of this study was to examine the role of sPsel in the diagnosis of venous thromboembolism (VTE).

Materials and Methods

We performed a systematic review and we used meta-analysis to synthesize data from published studies reporting sPsel levels in patients with i) VTE (deep venous thrombosis; DVT or DVT and pulmonary embolism; PE) and ii) DVT only. Pooled Odds Ratios (ORs) with 95% Confidence Intervals (CIs) were appropriately calculated among patients and controls. Diagnostic performance of sPsel was tested with pooled sensitivity, specificity, Diagnostic Odds Ratio (DOR) and summary receiver operator characteristic (SROC) curve.

Results

Eleven studies, comprising of 586 VTE patients and 1,843 controls were deemed eligible. The sPsel was significantly increased after VTE (OR = 2.89, 95%CI = 2.31-3.61, p < 0.001), or DVT only (OR = 2.64, 95%CI = 1.95-3.56, p < 0.001). Subgroup analysis evidenced that sPsel was also increased after VTE when evaluating only studies with patients that had no prior medical history (OR = 2.88, 95%CI = 1.98-4.19, p < 0.001). Exclusion of studies including patients with solid organ tumor, HIV or lupus anticoagulants positive patients did not alter findings. Pooled sensitivity and specificity of sPsel was 0.57 (95%CI = 0.30-082, p < 0.001) and 0.73 (95%CI = 0.51-0.90, p < 0.001), respectively and DOR was 4.31 (95%CI = 2.22-8.37, p < 0.01). SROC curve yielded in significant accuracy of sPsel performance (AUC = 0.74, p = 0.05).

Conclusions

The sPsel was significantly elevated in patients with DVT, both uncomplicated and complicated with PE and presented with high levels of diagnostic performance. sPsel is a plasma biomarker that may help in the diagnosis of VTE.     

Elevated risk of venous thromboembolism among post-traumatic brain injury patients requiring pharmaceutical immobilization

Traumatic brain injury (TBI) patients are known to have a high rate of venous thromboembolism (VTE), and additional neuromuscular blockade or barbiturate coma therapy has the theoretical risk of exacerbating baseline hemostasis and elevating the incidence of thromboembolic events. We conducted a single-institution retrospective review of patients surviving severe TBI, as determined by need for intracranial pressure (ICP) monitoring, who further required paralytics or barbiturate therapy to maintain ICP control. Patients were administered VTE prophylaxis as clinically appropriate. Predictors for VTE were subsequently determined with univariate and logistic multivariate regression analyses. The main cohort includes 144 patients, 34 of whom received pharmaceutical immobilization for ICP control. Mean ISS and GCS at intake were 31.9 and 5.2, respectively. Among those receiving vs not-receiving paralytics and/or barbiturate therapy, there was a statistical difference of 12/34 (35.3%) vs 18/110 (16.4%, p = 0.0280) in VTE events, at a mean time greater than two weeks from the time of trauma. Multivariate logistics regression indicated 3.2 times increased odds of developing a VTE (log odds = 1.17, p = 0.023). No pediatric patients were positive for an event (0/12 vs 7/22, p = 0.0356), and infections were only documented among those with VTE (0/22 vs 4/12, p = 0.0107). Overall, paralytics and barbiturate therapy were correlated with a higher incidence of VTE among TBI patients. Although the need for ICP control will outweigh an increase in thromboembolic risk, there is value for increased surveillance and screening during the prolonged inpatient stay of these patients.