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目的探讨儿茶酚胺氧位甲基转移酶(catechol-O-methyltransferase,COMT)基因多态性与动脉瘤性蛛网膜下隙出血(subarachnoid hemorrhage,SAH)后早期脑血管痉挛(cerebral vasospasm,CVS)的相关性。方法搜集重庆医科大学附属第一医院神经外科2008年1月至2008年12月收治的167例自发性SAH急性期(<3d)患者的临床资料。运用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术分析SAH患者COMT基因型及等位基因频率;运用TCD判定SAH患者早期CVS的严重程度;运用Hunt-Hess分级评估患者病情严重程度;运用头颅CT的Fisher分级评估出血量的多少。采用χ2检验和logistic回归分析等方法分析COMT基因分型结果等临床资料与CVS的相关性。结果各等位基因分布符合Hardy-Weinberg定律,研究样本为遗传平衡群体。A等位基因携带者的CVS发生率(51.7%)明显高于G等位基因携带者(38.5%)。A/A基因型患者CVS发生率(66.7%)明显高于G/G(35.9%)。单因素logistic回归分析提示A等位基因、A/A基因型和Hunt-Hess分级3~5级与CVS具有相关性。调整临床相关因素后,多因素logistic回归仍提示A等位基因、A/A基因型是SAH后早期CVS的危险因素。结论 COMTA等位基因、A/A基因型可能是SAH后早期CVS的危险因素。
Objective To investigate the correlation between catechol-O-methyltransferase (COMT) gene polymorphisms and early cerebral vasospasm (CVS) after aneurysm subarachnoid hemorrhage (SAH) Sex. Methods The clinical data of 167 patients with spontaneous SAH in acute stage (<3d) admitted to Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University from January 2008 to December 2008 were collected. The prevalence of COMT genotypes and alleles in patients with SAH was analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The severity of early CVS in patients with SAH was determined by TCD. The patient’s condition was evaluated by Hunt-Hess classification Severity; the use of head CT of the Fisher classification to assess the amount of bleeding. Chi-square test and logistic regression analysis were used to analyze the correlation between the clinical data such as COMT genotyping and CVS. Results The distributions of alleles were in accordance with Hardy-Weinberg’s law. The study samples were genetically balanced. The incidence of CVS in A allele carriers (51.7%) was significantly higher than that in G allele carriers (38.5%). The incidence of CVS in A / A genotype was significantly higher than that in G / G (66.7%) (35.9%). Univariate logistic regression analysis showed that A allele, A / A genotype and Hunt-Hess grade 3 to 5 were associated with CVS. Multivariate logistic regression still suggested A allele after adjustment for clinical related factors, and A / A genotype was a risk factor for early CVS after SAH. Conclusion The COMTA allele and A / A genotypes may be the risk factors of early CVS after SAH.