摘要
目的探讨亚甲基四氢叶酸还原酶(methylenetetrahydrofolate reductase,MTHFR)C677T基因多态性以及同型半胱氨酸(homocysteine,HCY)与早发冠心病(premature coronary artery disease,PCAD)的关系,为早期发现和干预疾病提供新证据。方法入选454例冠心病患者,根据男性是否≤65岁、女性是否≤55岁将患者分为PCAD组(n=174)和非PCAD组(n=280)。使用聚合酶链式反应—限制性片段长度多态分析法测定患者MTHFR-677基因型,采用水解循环酶法测定两组患者HCY水平,同时收集患者的临床及病史资料,并对患者进行12个月的随访记录。比较两组患者生化指标、病变特点、再发心血管事件差异,并通过二元Logistic回归分析MTHFR、HCY、叶酸(folic acid,FA)、TG、TC、性别等是否为PCAD的危险因素。结果PCAD组MTHFR-677C>T突变率、女性比例、TG、HCY水平显著高于非PCAD组(P<0.01),TC水平高于非PCAD组(P<0.05),而FA水平低于非PCAD组(P<0.05)。二元Logistic回归分析表明:MTHFR-677C>T突变导致PCAD发病风险增加106%(OR=2.06,95%CI 1.13~3.75),HCY是PCAD的发病危险因素(OR=1.04,95%CI 1.01~1.06),而女性PCAD发病风险是男性的2.12倍(OR=2.12,95%CI 1.39~3.24)。女性PCAD患者MTHFR-677C>T突变率高于男性患者(P<0.05),HCY水平显著高于男性患者(P<0.01)。PCAD组单支病变比例高于非PCAD组(32.18%vs 21.07%,P<0.01),多支病变比例明显低于非PCAD组(43.10%vs 54.29%,P<0.05)。12个月后PCAD组总心血管事件发生率与非PCAD组之间差异无统计学意义(P>0.05),但PCAD组女性总心血管事件发生率显著高于男性(16.09%vs 5.75%,P<0.05)。结论MTHFR-677C>T基因突变、HCY是PCAD的独立危险因素,对PCAD的发生有重要影响。
Objective To explore the clinical correlation among the methylenetetrahydrofolate reductase(MTHFR)C677T polymorphism,homocysteine(HCY)and premature coronary artery disease(PCAD),and provide new clinical evidences for the early detection and intervention of PCAD.Methods A total of 454 patients with coronary artery disease were enrolled in this study,and divided into PCAD group(n=174)and non PCAD group(n=280)in accordance with the age≤65 years for male and≤55 years for female,respectively.Polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP)and enzymatic cycling method were respectively used to test MTHFR-677 genotypes and determine HCY levels.The clinical data and medical records were collected,and the patients were followed up for 12 months.The difference in biochemical indexes,pathological characteristics and recurrent cardiovascular events were compared between the two groups,and binary logistic regression was adopted to determine whether MTHFR,HCY,folic acid(FA),TG,TC and gender were the risk factors for PCAD.Results The mutation rate of MTHFR-677C>T,the proportion of female patients,TG and HCY levels in PCAD group were significantly higher than those in non-PCAD group(P<0.01),TC level was higher,while FA level was lower in PCAD group than that in non-PCAD group(P<0.05).The results of binary logistic regression indicated that the mutated MTHFR-677C>T increased the morbidity of PCAD by 106%(OR=2.06,95%CI 1.13-3.75);HCY significantly raised the risk for PCAD(OR=1.04,95%CI 1.01-1.06);the morbidity of females was 2.12 times higher than that of males(OR=2.12,95%CI 1.39-3.24).The mutation rate of MTHFR-677C>T in female patients with PCAD was higher than that in male patients(P<0.05),while the HCY levels were significantly higher in female patients than those of male patients(P<0.01).The single vessel disease was higher in PCAD group than that in non-PCAD group(32.18%vs 21.07%,P<0.01),and the incidence of multi vessel disease was lower(43.10%vs 54.29%,P<0.05).No statistical significance was
作者
陈斌
康品方
李妙男
王洪巨
CHEN Bin;KANG Pinfang;LI Miaonan;WANG Hongju(Department of Cardiology,First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China)
出处
《山西医科大学学报》
CAS
2022年第8期992-997,共6页
Journal of Shanxi Medical University
基金
国家自然科学基金资助项目(81970313)
安徽省自然科学基金青年项目(1908085QH353)
蚌埠医学院自然科学重点项目(2020byzd075)。
关键词
早发冠心病
MTHFR基因
同型半胱氨酸
冠状动脉造影
premature coronary artery disease
methylenetetrahydrofolate reductase gene
homocysteine
coronary arteriography
