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血管紧张素转换酶基因多态性与体外循环围手术期心肌保护的相关性研究
Associations of Polymorphisms in Angiotensin Converting Enzyme Genes and Perioperative Myocardial Protection during Cardiopulmonary Bypass
【作者】 杨威；
【导师】 董啸；
【作者基本信息】 南昌大学 ， 外科学， 2012， 硕士
【摘要】 目的通过观察体外循环（CPB）围手术期血管紧张素转换酶（ACE）、血管紧张素II(AngII)及心肌标志物中的肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）、肌红蛋白（Myo）变化，探讨ACE基因多态性与CPB围手术期心肌保护之间的关系。方法随机抽取我院63例择期CPB下常规二尖瓣置换术治疗的风湿性二尖瓣狭窄的患者，采用PCR技术检测ACE基因的多态性，依照ACE的基因型分为三组（II型21人、ID型21人、DD型21人），分别对其CPB前（T1）、转流即刻（T2）、转流30min时（T3）、主动脉开放时（T4）、停转流时（T5）、术后2h（T6）、和术后24h（T7）各时间点抽取外周静脉血，ACE采用ELISA检测法、CK-MB和CTnI及Myo的检测采用化学发光酶免疫分析法；AngⅡ采用放射免疫分析法检测。并运用光学显微镜对患者的心肌超微结构改变情况进行观察。结果（1）ACE在CPB术中、术后各时间点均高于CPB前（P＜0.05），且随着CPB时间逐渐升高；（2）cTnI在CPB后各时点均高于CPB前（P＜0.05），T7达到高峰；（3）CK-MB在CPB后各时点均高于CPB前（P＜0.05），在T6时水平最高；（4）Myo在CPB后各时点与CPB前相比，差异有统计学意义（P＜0.05），T5和T7时有双峰；（5）ACE与cTnI存在明显相关性（P＜0.01），与Myo、CK-MB也有一定的相关性（P＜0.05）；（6）DD型与ID型、II型比较，其血清ACE、AngII以及cTnI浓度明显升高（p＜0.05）；（7）ID组与II组比较，仅有ACE、AngII有明显差异性（p＜0.05）。结论（1）CPB围手术期中ACE与cTnI、Myo、CK-MB有一定的相关性；（2）ACE DD基因型属于CPB围手术期心肌损伤的易感基因。
【Abstract】 Objective: To observe the expression of angiotensin converting enzyme (ACE),angiotensin II (AngII),cardiac troponin (cTnI), creatine kinase isozymes (CK-MB)and muscle red protein(Myo) after cardiopulmonary bypass (CPB). At the same timeto investigate the associations of Polymorphisms in Angiotensin converting enzymeGenes and myocardial injury.Methods： Sixty-three patients who suffered from rheumatic mitral stenosisscheduled for mitral valve replacement with CPB,were randomly divided into threegroups according Polymorphisms in Angiotensin converting enzyme Genes: type II,type ID, type DD (each=21).Blood samples were withdrawn from artery beforeoperation(T1), at the beginning of CPB(T2),30min after CPB(T3),(T4)at the end ofCPB(T5),2h after CPB(T6),6h after CPB(T7) to mearsure the expression of ACE,AngII, cTnI, CK-MB, Myo, cardium samples were collected for hematoxylin andeosin (HE) staining.Results: The level of ACE during and after CPB were significantly higher thanthose before CPB(P<0.05). As extension of CPB time,the expression of ACE isincreasing. The level of cTnI,CK-MB, Myo after CPB were significantly higher thanthose before CPB(P<0.05).The level of cTnI,CK-MB and Myo are highest at T7, T6and T5and T7, respectively.The level of ACE, AngII, cTnI in patients with DDgenotype was significantly higher than the ID and II genotype (p <0.05).Besides, thelevel of ACE, AngII in patients with ID genotype was significantly higher than the II(p <0.05).Conclusion：(1) CPB perioperative midterm ACE and cTnI、Myo、CK-MB tohave certain correlation；(2) ACE DD genotype belongs to susceptibility genesof the CPB perioperative myocardial injury.