冠状动脉痉挛患者自主神经功能及其相关基因多态性的临床研究

摘要

目的 探讨冠状动脉痉挛(CAS)患者双重特异性A型激酶锚定蛋白2功能多态性[AKAP10 (A/G) I646V)]的基因型分布情况及与自主神经功能的关系.方法 选择冠脉造影证实的CAS患者58例为研究对象,冠脉造影阴性患者58例设为对照组.采用心率变异性(HRV)时域指标评价自主神经功能.比较两组患者AKAP10的基因分布情况及HRV指标[正常窦性RR间期总体标准差( SDNN),24 h每5 min窦性R-R间期平均值的标准差(SDANN);24 h正常相邻窦性R-R间期差值的均方根(RMSSD),正常连续窦性RR间期超过50 ms的NN间期所占百分数(PNN50)]的异同.结果 CAS组患者平均心率高于对照组,差异有统计学意义(P<0.05);CAS组HRV时域指标SDNN、SDANN、RMSSD、PNN50均明显低于对照组,差异有统计学意义(P<0.05);CAS组AA、AG、GG基因型频率分别为31.0%、39.7%、29.3%,对照组则为53.4%、32.8%、13.8%.CAS组A、G等位基因的频率分别为54%、46%,对照组A、G等位基因的频率分别为70%、30%,CAS患者携带AKAP10基因G等位基因的比率明显高于对照组(P<0.01).结论 CAS患者携带AKAP10基因G等位基因的比率明显高于对照组,同时HRV时域指标均低于对照组,因此AKAP10基因多态性可能通过影响自主神经的功能而影响CAS的发生.%Objective To investigate the relationship between the genotype distribution of AKAP10 (A/G) I646V and autonomic nervous function in coronary artery spasm(CAS)patients.Methods We enrolled58 CAS patients and 58 control patients in our experiment.Genomic polymorphisms of AKAP10 were determined by using polymerase chain reaction.Autonomic nervous function was evaluated by using the time domain indexes of heart rate variability(HRV).The difference of the genomic polymorphisms of AKAP10 and indexes of HRV were compared.Results The average heart rate in CAS group was higher than that in control group (P<0.05).In CAS group, SDANN, RMSSD, PNN50, SDNN were significantly lower than those in control group (P<0.05).In CAS group, frequencies of AA AG, GG genotype were 31%, 29.3% and39.7% respectively, while in control group, they were 53.4%, 13.8% and 32.8%, respectively.The frequencies of allele A and G in CAS group were 54% and 46% while 70% and 30% in control group.There were significant differences in genotype and allele frequency distribution between the two groups (P<0.01).Conclusion The frequencies of G allele of AKAP10 gene in CAS patients was significantly higher than the control group while the time domain indexes of HRV were lower than that of the control group, so AKAP10 gene polymorphism may affect the occurrence of CAS by influencing the function of autonomic nerve.