| Background and objectiveWith the progress of medical technology and the improvement of people's living standards,the number of cardiac surgery in our country has been increasing year by year.From 9,0812 cases in 2004 rose to 2013 in 20,7881 cases,the average annual growth rate was 9.64%.The number of cases of cardiopulmonary(CPB)bypass increased from 7,4840 in 2004 to 16,2254 in 2013.The average annual growth rate was 8.93%.Valve surgery is an important part of CPB cardiac surgery.CPB often leads to complex physiological and pathological changes in the body,especially the coagulation function.Coagulation dysfunction is an important factor for postoperative bleeding,reoperation,perioperative blood transfusion,and affect the prognosis of patients,increase the length of stay,increase the economic burden of patients.Fibrinolytic system is an important protective mechanism to inhibit thrombosis,and plasminogen activator inhibitor-1(PAI-1)is an important fibrinolytic regulator.The results showed that the plasma PAI-1 concentration was mainly related to the level of gene expression.Some gene polymorphisms influence the level of gene expression,among which the 4G/5G gene polymorphism of PAI-1 gene is the most important.A large number of studies have shown that the 5G allele of PAI-1 gene can reduce the plasma PAI-1 concentration by lowering the expression of PAI-1 gene,and inhibit the activity of fibrinolytic system.The purpose of this study is through the study of CPB patients undergoing operation for PAI-1 gene 4G/5G polymorphism and plasma PAI-1 concentration,blood routine,coagulation related indicators and observe the perioperative blood loss,blood product usage and hospitalization time to explore whether there is a correlation between them.MethodsWe selected 69 adult patients undergoing selected cardiac valve surgery from October 2016 to January 2017 in the First Affiliated Hospital of Zhengzhou University.Inclusion criteria: age 18 to 65 years old;body mass index 18 ~ 25kg/m2;echocardiography and chest X-ray examination showed LVEF ?35%,left ventricular end diastolic diameter ? 80 mm,cardiothoracic ratio ?0.80;expected CPB time 1~2h.Exclusion criteria: coagulation dysfunction history: prothrombin time prolonged more than 5s or the INR > 1.5,plasma fibrinogen concentration < 1.5 g/L,platelet count <100 × 109/L,severe liver/renal disease or other contraindications;taken drugs affecting the blood coagulation function in the last 7 days,such as heparin,salvia miltiorrhiza,aspirin,dipyridamole;emergency or reoperation patients.After entering the operation room patients were conducted with upper limb vein puncture catheterization and infusion.Then the ECG was monitored regularly,and the endotracheal intubation was performed after anesthesia induction.The patient was transferred to ICU after surgery.Blood samples were collected from patients at the day before surgery to detect genotype.The patients were divided into 5G group and 4G group according to the results of genotype detection.The 5G group included all patients with 5G allele,namely 4G/5G and 5G/5G,4G group was 4G/4G genotype.Blood samples were collected to detect the concentration of plasma PAI-1,routine blood test,blood coagulation test on the day before surgery,1h after CPB and 24 hours after surgery.The surgery time,cardiopulmonary bypass time,aortic clamping time,the volume of prime solution were observed,and the volume of mediastina pericardial drainage,blood product usage,staying time in ICU and hospitalization time were observed after surgery.Statistical analysisData were collected and analysed by SPSS version 23.0 software.Quantitative data were expressed as mean ± SD.Use LSD-t for further analysis between two groups.Levels of significance test is ? = 0.05.Results1.Finally,65 patients were included in the study.22 patients were 4G/4G carriers,29 patients were 4G/5G carriers and 14 patients were 5G/5G carriers.Therefore,there were 22 patients in 4G group and 43 patients in 5G group.2.The plasma PAI-1 concentration of the patients in group 4G was higher than that of 5G group at the day before operation,1h after CPB and 24 hours after operation(P< 0.05).3.The volume of mediastina pericardial drainage,the usage of ordinarily frozen plasma and suspended red blood cells were much higher of the patients in group 5G than that of 4G group(P< 0.05),and the hospitalization time of patients in 5G group was significantly longer(P< 0.05).4.Red blood cell count,hemoglobin in 5G group were significantly lower than those in 4G group at 1h after CPB(P< 0.05).5.The prothrombin time in the 5G group was significantly longer than that in the 4G group at 1h after CPB(P < 0.05).At 1h after CPB and 24 hours after operation the plasma fibrinogen concentration in the 5G group was lower than that in the 4G group,but the plasma imer concentration in the 5G group was higher than that in the 4G group(P < 0.05).Conclusion1.The 4G/5G polymorphism of PAI-1 gene affects the perioperative plasma PAI-1 concentration in patients undergoing valve surgery,among which 4G/4G genotype patients are higher than those of 5G allele carriers,4G/5G and 5G/5G genotype patients.2.PAI-1 gene 4G/5G polymorphism affects plasma coagulation function in patients undergoing valve surgery by affecting PAI-1 concentration.The 5G allele carriers,4G/5G and 5G/5G genotype patients,had more bleeding,longer hospitalization time,more blood products usage and heavy economic burden than those with 4G/4G genotype. |
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