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

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。

Association of PON1(rs662) gene polymorphism with high platelet reactivity in post-PCI patients

OBJECTIVE To explore the association of PON1(rs662) gene polymorphism with high platelet reactivity in post-PCI patients.METHODS A total of 279 patients post PCI were enrolled.Clopidogrel 75 mg·d^-1and aspirin 100 mg·d^-1 were administered after PCI.High platelet reactivity (HPR) was defined as adenosine diphosphate (ADP) induced platelet inhibition rate < 50%.The independent risk factors of HPR were explored by univariate and multivariate logistic regression analysis.A receiver operating characteristic curve was used to evaluate the efficacy of independent risk factors in predicting HPR.RESULTS The incidence of HPR after PCI was 19.0% in 279 patients.Logistic regression analysis revealed that PON1(rs662) A allele (OR=2.101,95%CI=1.002-4.406,P=0.049) and diabetes (OR=1.921,95%CI=1.023-3.604,P=0.042) were independent risk factors of HPR.The results of ROC curve demonstrated a satisfactory predictive value for combined independent risk model,with the area under the curve being 0.680 (95%CI=0.600-0.760,P<0.001).CONCLUSION PON1(rs662) A allele and diabetes may be risk factors of HPR in patients after PCI.Combined independent risk model holds a satisfactory predictive value in diagnosing HPR.