慢性风湿性心脏病患者CYP3A4同工酶基因多态性研究

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目的：探讨慢性风湿性心脏病（CRHD）患者CYP3A4同工酶基因多态性与超声心动图（EchoCG）、肺活量和内皮功能的关系。

材料与方法：128例慢性风湿性心脏病患者（15.6%男性和84.4%女性）接受了检查。从静脉血白细胞中分离DNA后，用多态标记A392A、A392G、G392G进行基因分型，采用PCR方法，电泳检测结果为“SNP-EXPRESS”（RPC Litech，俄罗斯）。在Affinity 50装置（Philips， 荷兰）上进行超声心动图检查，在AngioScan01装置（AngioScan - Electronics，俄罗斯）上评估内皮功能，在SpiroLab II肺量计（MIR Medical，意大利）上评估呼吸功能。

结果。6分钟步行测试的距离在两组中没有显著差异：A392A—327.47±6.71 m，A392G—303.63±26.19 m，G392G—338.87±20.12 m（p=0.505）， 以及二尖瓣开口面积：A392A—1.74（1.67;1.81）cm2，A392G—1.68（1.45;1.92）cm2，G392G—1.65（1.67;1.81）cm2（р=0.214）。EchoCG参数显示，G392G纯合子组左心室线性尺寸最小（舒张末期大小为4.83（4.72;4.95）cm，最终收缩期大小为2.97（2.79;3.14）cm，右心室为2.45（2.32;2.58）cm，右心房为4.09（3.56;4.62）cm及左室肥厚（室间隔厚度为0.88（0.81;0.95）cm，后壁为0.88（0.81;0.95）cm。两组患者的咬合指数振幅差异无统计学意义，即CYP3A4单核苷酸取代对小阻性动脉系统没有影响，而通道间的相移值（反映大动脉状态）有显著差异。G392G的多态性以最差指标来区分：A392A组的变化很小。轮廓分析结果显示，G392G组的增强指数最高，反映了最大的血管刚度。在研究队列患者中，CYP3A4多态性对呼吸功能参数没有影响。根据肺活量指标，阻塞性和限制性指标值均未达到统计学意义，虽然肺活量76.5%（71.1;82.0）和1 s形成呼气量84.6%（79.0;90.3）在纯合子中最大，肺活量在纯合子A392A中最大85.6%（82.3;88.8）。

结论。在慢性风湿性心脏病患者中，G392G为纯合子，显示了左心室腔的肥厚和大小的最小指标，以及右心室腔的最小值。未获得CYP3A4多态性对CRHD患者外呼吸功能参数的影响。

作者简介

Vadim Petrov

Ryazan State Medical University

编辑信件的主要联系方式.
Email: dr.vspetrov@gmail.com
ORCID iD: 0000-0001-8631-8826
SPIN 代码: 4553-3581

MD, Dr.Sci.(Med.), Associate Professor of the Hospital Therapy Department with Medical and Social Expertise Course

俄罗斯联邦, Ryazan

Alexander Nikiforov

Ryazan State Medical University

Email: a.nikiforov@rzgmu.ru
ORCID iD: 0000-0002-7364-7687
SPIN 代码: 8366-5282

MD, Cand.Sci.(Med.), Head of the Central Research Laboratory

俄罗斯联邦, Ryazan

Elena Smirnova

Ryazan State Medical University; Ryazan Regional Clinical Cardiology Dispensary

Email: Smirnova-EA@inbox.ru
ORCID iD: 0000-0003-0334-6237
SPIN 代码: 6503-8046
Researcher ID: Y-1235-2018

MD, Dr.Sci.(Med.), Associate Professor of the Hospital Therapy Department with the Course of Medical and Social Expertise

俄罗斯联邦, Ryazan; Ryazan

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