目的 探讨亚甲基四氢叶酸还原酶(methylene tetrahydrofolate reductase,MTHFR)C677T基因多态性、血清同型半胱氨酸(homocysteine,Hcy)水平与下肢动脉硬化闭塞症(arteriosclerosis obliterans,ASO)患者介入术后再狭窄的关系.方法 选取2021年1月至2022年7月于温州市中心医院就诊的92例下肢ASO患者作为研究对象,根据术后再狭窄情况分为未再狭窄组和再狭窄组.收集患者的一般资料和手术资料,并检验术前中性粒细胞、淋巴细胞、血小板、纤维蛋白原、D-二聚体、C反应蛋白、低密度脂蛋白、Hcy、MTHFR C677T基因多态性等,采用x2检验及Logistic回归分析比较下肢ASO介入术后再狭窄与MTHFR C677T基因多态性、血清Hcy的关系.构建风险评分系统预测介入术后再狭窄,并评估其有效性.结果 两组患者的病变位置、支架置入、支架长度、血清Hcy、MTHFR C677T基因多态性比较,差异有统计学意义(P＜0.05).多因素Logistic回归分析显示MTHFR C677T TT型、血清Hcy≥ 17.15μmol/L、病变位于股动脉、无支架置入是下肢ASO患者介入术后再狭窄的独立危险因素(P＜0.05).根据独立危险因素构建的风险评分系统受试者操作特征曲线下面积(area under the curve,AUC)为0.818(95％CI:0.731～0.905),明显高于其他独立危险因素,具有较高的效能.结论 MTHFR C677T基因多态性、血清Hcy与下肢ASO患者介入术后再狭窄密切相关.基于MTHFR C677T基因多态性、血清Hcy、病变位置及支架置入构建的风险评分系统有助于预测下肢ASO患者再狭窄的发生.
Relationship between MTHFR C677T gene polymorphism and serum Hcy with restenosis after intervention in lower limb arteriosclerosis obliterans
Objective To explore the relationship between methylene tetrahydrofolate reductase(MTHFR)C677T gene polymorphism and serum homocysteine(Hcy)levels with postoperative restenosis in patients with lower limb arteriosclerosis obliterans(ASO)after intervention.Methods A total of 92 patients with lower limb ASO treated in Wenzhou Central Hospital from January 2021 to July 2022 were divided into non-restenosis group and restenosis group according to whether patients with postoperative restenosis.General and surgical data from all patients were collected,and preoperative neutrophils,lymphocytes,platelets,fibrinogen,D-dimer,C-reactive protein,low-density lipoprotein,homocysteine,MTHFR C677T gene polymorphism,etc were tested.x2 test and Logistic regression analysis were used to compare the relationship between lower limb ASO postoperative restenosis after intervention and MTHFR C677T gene polymorphism and serum Hey.A risk scoring system was built to predict postoperative restenosis after intervention and evaluate its effectiveness.Results There were significant differences(P＜0.05)between the two groups in terms of lesion location,stent placement,stent length,serum Hcy,and MTHFR C677T gene polymorphism.Multivariate Logistic regression analysis showed that MTHFR C677T TT type,serum Hey 17.15μmol/L,lesion location in the femoral artery,and no stent placement were independent risk factors for postoperative restenosis in lower limb ASO patients(P＜0.05).The area under the curve(AUC)of receiver operating characteristic curve of the risk scoring system constructed based on independent risk factors was 0.818(95％CI:0.731-0.905),which was significantly higher than those other independent risk factors and had high efficacy.Conclusion The MTHFR C677T gene polymorphism and serum Hcy are closely related to postoperative restenosis in lower limb ASO patients.A risk scoring system based on MTHFR C677T gene polymorphism,serum Hcy,lesion location,and stent placement can help predict the occurrence of restenosis in lower limb ASO patients.
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