炎症基因多态性和心脏手术后手术后心肌梗塞的风险
M V Podgoreanu1, W D White, R W Morris
1Department of Anesthesiology, Box 3094, Duke University Medical Center, Durham, NC 27710, USA. mihai.podgoreanu@duke.edu
Circulation
|July 6, 2006
概括
炎症途径的遗传变异预测了心脏手术后的术后心肌梗塞 (PMI) 风险. 识别这些基因多态可能有助于识别高风险患者并开发新的心脏保护策略.
科学领域:
- 心血管医学 心血管医学
- 遗传学 是一个遗传学.
- 免疫学 免疫学 免疫学
背景情况:
- 通过心肺旁路 (CPB) 的心脏手术引发了炎症反应,导致手术后心肌梗塞 (PMI).
- PMI表现出显著的患者间变异性,现有临床因素无法预测.
- 在炎症途径中的候选基因多态性被调查为PMI的潜在风险因素.
研究的目的:
- 测试假设,在炎症途径中候选基因多态化有助于心脏手术后PMI的风险.
- 为了确定与PMI发展相关的特定遗传变异.
- 评估遗传信息是否可以改善PMI预测模型.
主要方法:
- 一个由434名患者组成的前性队列,他们接受了CPB的选择性心脏手术,在23个候选基因中对48个多态基因进行了基因定型.
- 术后24小时内肌酸激酶-MB水平升高定义了PMI.
- 使用两步分析,包括顺序分析,邦费罗尼校正和错误发现率控制,以调整多重测试.
主要成果:
- 12%的患者 (52/434) 经历了PMI.
- 在调整临床风险因素和多重比较后,三个多态独立预测了PMI.
- 这些包括介质素6 (IL6),细胞间粘附分子-1 (ICAM1) 和E-选择素 (SELE) 的变异.
结论:
- 细胞因子和白细胞-内皮细胞相互作用途径中的功能遗传变异与心肌损伤严重程度的心脏手术后独立相关.
- 这些发现可能有助于在手术前识别患有PMI高风险的患者.
- 这项研究可以为开发新型心脏保护策略提供信息.
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