Deletion Polymorphism in the Angiotensin-converting Enzyme Gene as a Thrombophilic Risk Factor after Hip Arthroplasty
Deletion Polymorphism in the Angiotensin-converting Enzyme Gene as a Thrombophilic Risk Factor after Hip Arthroplasty
复制标题
血管紧张素转换酶基因的缺失多态性是髋关节置换术后血栓形成的危险因素
作者：
C. Philipp;A. Dilley;P. Saidi;B. Evatt;H. Austin;J. Zawadsky;D. Harwood;D. Ellingsen;Elizabeth R. Barnhart;Donald Phillips;W. Hooper
总结尽管采取了血栓预防措施，深静脉血栓形成仍是骨科大手术的常见并发症。易感的遗传风险因素尚不清楚。在这项病例对照研究中，我们调查了85例择期全髋关节置换术患者血管紧张素转换酶（ACE）基因插入（I）/缺失（D）多态性、凝血因子V莱顿（R506 Q）突变和5，10亚甲基四氢叶酸还原酶（MTHFR）基因多态性与术后静脉血栓形成的相关性。髋关节手术后，ACE基因DD型受试者发生血栓事件的几率比II型受试者高10倍以上（比值比11.7 [95%置信区间2.3-84.5]）;与II基因型相比，ID基因型的受试者中其增加了5倍（优势比5.0 [95%置信区间1.1-34.9]）。研究时未使用ACE抑制剂的对照受试者（n = 43）的平均血浆ACE水平在I等位基因纯合子患者中最低（18.9 ± 7.95 U/l），在ID基因型患者中居中（31.6 ± 10.8 U/l），在D等位基因纯合子患者中最高（44.0 ± 7.14 U/l）。病例组平均血浆ACE水平（33.0 U/l，n = 25）高于对照组（29.4 U/l，n = 43），但差异无统计学意义。凝血因子V Leiden突变和MTHFR基因多态性均不增加髋关节置换术后血栓形成的风险。这些结果表明I/D ACE基因多态性是全髋关节置换术受试者血栓形成的潜在危险因素。
Summary Despite thromboprophylaxis, deep vein thrombosis is a common complication of major orthopedic surgery. Predisposing genetic risk factors are unknown. In this case-control study, we investigated the association of the insertion (I)/deletion (D) angiotensin converting enzyme (ACE) gene polymorphism, Factor V Leiden (R506Q) mutation, and 5,10 methylenetetrahydrofolate reductase (MTHFR) gene polymorphism with post-operative venous thrombosis in 85 patients who underwent elective total hip arthroplasty. The odds of a thrombotic event following hip surgery among subjects with the DD genotype of the ACE gene was increased more than 10-fold compared to subjects with the II genotype (odds ratio 11.7 [95% confidence interval 2.3-84.5]); it was increased 5-fold in subjects with the ID genotype compared to the II genotype (odds ratio 5.0 [95% confidence interval 1.1-34.9]). Mean plasma ACE level in control subjects not on ACE inhibitors at the time of study (n = 43) was lowest in persons homozygous for the I allele (18.9 ± 7.95 U/l), intermediate in patients with the ID genotype (31.6 ± 10.8 U/l) and highest in subjects homozygous for the D allele (44.0 ± 7.14 U/l). Mean plasma ACE level among cases was higher (33.0 U/l, n = 25) than among controls (29.4 U/l, n = 43) but this difference was not statistically significant. Neither the Factor V Leiden mutation nor MTHFR gene polymorphism increased the risk of thrombosis following hip replacement. These results demonstrate that the I/D ACE gene polymorphism is a potent risk factor for thrombosis in subjects undergoing total hip arthroplasty.
静脉血栓形成倾向中凝血因子 Va 异常与活化蛋白 C 抵抗相关。
影响因子：
20.3
作者：
Sun,X;Evatt,B;Griffin,JH
通讯作者：
Griffin,JH
影响因子：
15.9
作者：
RAKUGI, H;KIM, DK;PRATT, RE
通讯作者：
PRATT, RE