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目的探讨经皮冠状动脉介入术(PCI)后重度血瘀证与血浆遗传性假血友病因子(vWF)水平及CYP2C19*2基因多态性的相关性。方法将371例PCI成功的冠心病患者根据术后1周血瘀证评分标准分为非血瘀组(77例)、轻度血瘀组(193例)和重度血瘀组(101例)3组,采用PCR-RFLP基因分析方法检测CYP2C19*2基因多态性,同时采血检测血小板计数(PLT)、最大血小板聚集率(MPA)、vWF和纤维蛋白原(Fg)。结果重度血瘀组CYP2C19*2基因突变型(GA+AA)明显高于轻度血瘀组和非血瘀组(χ2=27.093,P<0.001)。多因素Logistic回归分析显示,以非血瘀组为参照系,CYP2C19*2基因突变型(GA+AA)患重度血瘀证的相对危险度(OR)为3.371(95%CI:1.557~7.295,P=0.002)。重度血瘀组MPA及vWF高于轻度血瘀组,差异有统计学意义(P<0.05)。血浆vWF的ROC曲线分析指出,vWF≥118.10%(敏感性为0.842,特异性为0.767,辨证准确率为78.6%,Youden指数0.609),中医辨证为重度血瘀证的可能性较大。结论 PCI术后CYP2C19*2基因突变患者可能易患重度血瘀证,血浆vWF测定可作为其重要的微观辨证指标。
Objective To investigate the relationship between severe blood stasis syndrome and plasma hereditary von Willebrand factor (vWF) level and CYP2C19 * 2 gene polymorphism after percutaneous coronary intervention (PCI). Methods A total of 371 patients with coronary artery disease undergoing PCI were divided into non-blood stasis group (n = 77), mild stasis group (n = 193) and severe stasis group (n = 101) The polymorphism of CYP2C19 * 2 gene was detected by PCR-RFLP gene analysis. PLT, MPA, vWF and fibrinogen (Fg) were detected by blood sampling. Results The genotypes of CYP2C19 * 2 gene mutation (GA + AA) in severe blood stasis group were significantly higher than those in mild blood stasis group and non-blood stasis group (χ2 = 27.093, P <0.001). Multivariate Logistic regression analysis showed that relative risk (OR) of CYP2C19 * 2 gene mutation (GA + AA) with severe blood stasis syndrome was 3.371 (95% CI: 1.557-7.295, P = 0.002). Severe blood stasis group MPA and vWF were higher than mild stasis group, the difference was statistically significant (P <0.05). ROC curve analysis of plasma vWF showed that vWF≥118.10% (sensitivity of 0.842, specificity of 0.767, accuracy rate of 78.6% for syndromes, Youden index 0.609), TCM syndrome is more likely to have severe blood stasis syndrome. Conclusion Patients with CYP2C19 * 2 gene mutation may be susceptible to severe blood stasis syndrome after PCI, and plasma vWF can be used as an important microembolism index.