冠脉介入治疗后止凝血功能的改变及其与PAI基因多态性的关系

目的：探讨经皮冠状动脉介入术( PCI)后止凝血功能变化与纤溶酶原激活剂抑制物-1 (PAI-1) 基因启动子区-675 4G/5G 多态性的关系，为临床PCI后预测血栓形成提供依据。方法：86例行PCI的冠心病患者分别于术前、术后即刻、术后24 h肘静脉采血,检测血浆中血管性血友病因子( vWF) 、PAI-1、FⅦc活性及血小板α颗粒膜蛋白-140（GMP-140 ）、D-二聚体(D-D)含量;应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法检测基因型及不同基因型患者PCI前、后止凝血功能指标。结果：PAI-1 基因型频数分布为4 G/4 G 型48 例（56%）,4 G/5 G30 例（35%）,5 G/5 G 型 8 例（9%）。4 G 和5 G 等位基因频率分别为73%和27%。3组基因型患者术前各项指标比较差异无显著性（P>0.05）。具有PAI-1 4G/4G 基因型患者血浆vWF、PAI-1、FⅦc活性及GMP-140、D-D含量在术后即刻高于术前( P< 0.01)；术后24 h PAI-1活性高于术前(P< 0.01)，但vWF、FⅦc活性及GMP-140、D-D含量有所下降,与术前比较差异无显著性（P>0.05）。具有4G/5G基因型及5G/5G基因型的两组患者术后即刻各项指标较术前明显增高( P< 0.01)；术后24 h较术前有增高趋势,但差异均无显著性（P>0.05）。4 G/4 G 型患者术后即刻及术后24 h PAI-1活性较另两组基因型患者增高更显著( P< 0.01)；其他指标有增高趋势，但差异无显著性(P>0.05)。结论：具有PAI-1 4 G/4G 基因型患者在PCI后较4 G/5 G型及5 G/5 G 型患者存在明显的纤维蛋白溶解功能的改变，提示PAI-1 4G/4G基因可能是PCI后急性和亚急性冠状动脉血栓形成的危险基因型。

Changes of homeostatic activation in patients after percutaneous coronary intervention and its relationship with plasminogen activator inhibitor-1 gene polymorphism

Objective To investigate the relationship between plasminogen activatorinhibitor-1(PAI-1) 4G/5G gene polymorphism and homeostatic activation after percutaneous coronary intervention(PCI),and provide foundation for clinic detection of thrombosis after PCI.Methods The plasma von Willebrand factor(vWF),activated factor Ⅶ(FⅦc),PAI-1 activities and GMP-140,D-dimers(D-D) levels in 86 patients with coronary heart disease undergoing in-stent implantation were determined before and immediate postoperative,and 24 h after PCI.PAI-1 gene polymorphism was detected by polymerase chain reaction restriction fragment length polymorphism(PCR-RFLP) to observe the changes of platelet function and coagulation and fibrinolytic states before and after PCI.Results The distribution of PAI1 genotypes was as follows:48 cases with 4G/4G(56%),30 cases with 4G/5G(35%)and 8 cases with 5G/5G(9%).Among the patients,the allelic frequencies of 4G and 5G were 73% and 27% respectively.No significant difference of the plasma GMP-140,vWF,FⅦa,D-D and PAI-1 levels was found between the three genotypes before PCI(P>0.05).In the patients with 4G/4G polymorphism of PAI1 gene,the GMP-140,vWF,FⅦa,D-D and PAI-1 levels in plasma were significantly increased at immediate postoperative period(P<0.01).The PAI-1 levels in plasma were significantly increased 24 h after PCI(P< 0.01);but the GMP-140,vWF,FⅦa and D-D levels did not significantly increase(P>0.05).In the patients with 4G/5G and 5G/5G genotypes,all indexes mentioned above were significantly increased at immediate postoperative period(P<0.01);24 h after PCI there were no significant differences(P>0.05).In the patients with 4G/4G genotype,the PAI-1 level in plasma was significantly higher than those in the patients with 4G/5G and 5G/5G genotypes 24 h after PCI(P< 0.01).Conclusion There is a remarkable homeostatic activation and the fibrinolytic activity changes more in patients with 4G/4G genotype than those in patients with 4G/5G and 5G/5G genotypes after PCI.The results suggest that the patients with 4G/4G genotype may be a dangerous factor in acute or subacute coronary thrombosis after PCI