CAJ | 학술논문

目的：探讨血小板膜糖蛋白（GP）Ⅱb HPA-3基因多态性与急性冠脉综合征（ACS）经皮冠状动脉介入治疗（PCI）前后血小板功能变化的关系。方法选择行 PCI的ACS患者120例测定GPⅡb HPA-3基因型，测定各基因型 PCI术前、术后即刻、术后24 h三个时间段血浆GMP-140、vWF和PAI-1浓度。对不同基因型PCI前后血小板功能指标进行对比。结果经Logistic回归分析校正各因素后发现：GPⅡbHPA-3 bb基因型是心肌梗死的独立危险因素。GMP-140在bb基因型组PCI术后即刻、术后24 h较aa、ab基因型均增高（P＜0．01）。vWF三种基因组差异无统计学意义。PAI-1 bb在基因组PCI术后即刻比aa、ab基因型存在更明显的PAI-1活化（P＜0．01）。结论血小板GPⅡb HPA-3bb基因型可能是心肌梗死的独立危险因素，并且该基因型ACS患者在 PCI术后存在更迅速、更显著的血小板活化，提示bb基因型可能是PCI后血栓负荷过重和术后心血管事件的危险因素。
목적：탐토혈소판막당단백（GP）Ⅱb HPA-3기인다태성여급성관맥종합정（ACS）경피관상동맥개입치료（PCI）전후혈소판공능변화적관계。방법선택행 PCI적ACS환자120례측정GPⅡb HPA-3기인형，측정각기인형 PCI술전、술후즉각、술후24 h삼개시간단혈장GMP-140、vWF화PAI-1농도。대불동기인형PCI전후혈소판공능지표진행대비。결과경Logistic회귀분석교정각인소후발현：GPⅡbHPA-3 bb기인형시심기경사적독립위험인소。GMP-140재bb기인형조PCI술후즉각、술후24 h교aa、ab기인형균증고（P＜0．01）。vWF삼충기인조차이무통계학의의。PAI-1 bb재기인조PCI술후즉각비aa、ab기인형존재경명현적PAI-1활화（P＜0．01）。결론혈소판GPⅡb HPA-3bb기인형가능시심기경사적독립위험인소，병차해기인형ACS환자재 PCI술후존재경신속、경현저적혈소판활화，제시bb기인형가능시PCI후혈전부하과중화술후심혈관사건적위험인소。
Objective To investigate the possible relationship between platelet membrane glyco-protein (GP) IIb HPA-3gene polymorphism and changes of platelet function and the fibrinolytic activi-ty in patients with acute coronary syndrome (ACS ) ,undergoing percutaneous coronary intervention (PCI) .Methods 120 patients ,who were definitely diagnosed with ACS in the Affiliated Hospital of Guiyang Medical College ,were chosen to check platelet GP IIb HPA-3 gene polymorphism by polymer-ase chain reaction-sequence specific primers (PCR-SSP ) .Before and after PCI immediately ,and 24 hours after PCI ,the plasma GMP-140 ,vWF and PAI-1 levels were determined to analysis the change of platelet function indicators in patients with different genotype .Results The Logistic regression analysis found that GP Ⅱ bHPA -3 bb genotype is a independent risk factor for acute myocardial infarction (AMI) after correction factors .The plasma GMP-140 level in the bb genotype group was remarkably increased immediately and 24 hours after PCI among the three genotypes (P< 0 .01) .The plasma vWF level no statistical difference appeared among the three genotypes .The plasma PAI-1 level imme-diately after PCI ,there were statistical significantly differences between the bb genotype and the others (P<0 .01) .Conclusion The HPA-3 polymorphism of GP IIb is the risk factor of AMI .There is re-markable platelet activation and the fibrinolytic activity changes in patients with GP HPA-3bb geno-type than in those without it after PCI .The results are suggested that the bb genotype of platelet GP IIb HPA-3 maybe a dangerous factor in acute and sub-acute coronary thrombosis after PCI .