Relationship between the MTHFR C677T Gene Polymorphism and the Collateral Circulation in Patients with Carotid Stenosis
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摘要:
目的 研究MTHFR C677T基因多态性与颈动脉狭窄及其侧支循环形成的关系。 方法 收集2018年10月至2021年3月昆明医科大学第二附属医院脑血管病科通过DSA诊断颈动脉中重度狭窄或慢性闭塞的患者65例，无明显颈动脉狭窄的对照组45例。所有患者完成一般情况评估。颈动脉中重度狭窄或慢性闭塞的65例患者DSA ASITN评分评估侧支循环分级。所有患者完成MTHFR C677T 基因多态性检测。 结果 颈动脉中重度狭窄及慢性闭塞的患者既往卒中发生率显著高于对照组。颈动脉中重度狭窄及慢性闭塞组的年龄、吸烟史、高血压、糖尿病史、总胆固醇、低密度胆固醇脂蛋白、同型半胱氨酸及MTHFR C677T基因CT/TT型占比差异有统计学意义（P < 0.05）。在中重度颈动脉狭窄或慢性颈动脉闭塞患者中，侧支循环开放良好者（3～4级）CC型所占比例高于TT/CT型，而侧支循环开放不良（1-2级）者TT/TC型较多，组间比较差异有显著性意义（ P < 0.05）。 结论 MTHFR 基因CT/TT型是颈动脉狭窄的危险因素。较CC型，CT/TT型颈动脉狭窄患者侧支循环开放更差。 -
关键词:
- 颈动脉狭窄 /
- MTHFR C677T 基因多态性 /
- 侧支循环
Abstract:Objective To study the relationship between the MTHFR C677T gene polymorphism and the collateral circulation in patients with carotid stenosis. Methods A total of 65 patients with moderate or severe carotid stenosis and chronic occlusion diagnosed by DSA and 45 controls without carotid stenosis from October 2018 to March 2021 in our hospital were included. All patients completed general assessment. 65 patients with moderate or severe carotid stenosis and chronic occlusion were evaluated the collateral circulation ASITN grading by DSA . All patients completed MTHFR C677T genetic polymorphism test. Results The incidence of stroke in patients with moderate or severe carotid stenosis and chronic occlusion was significantly higher than that in control group. There were significant differences in age, smoking history, hypertension, diabetes, total cholesterol, low density cholesterol lipoprotein, homocysteine and CT/TT type of MTHFR C677T gene between carotid artery stenosis or chronic occlusion group and control group （P < 0.05）. The patients with good collateral circulation （ASITN grade 3-4） had high proportion of CC type in moderate or severe carotid stenosis and chronic carotid occlusion group. And the TT/TC type were more in patients with poor collateral circulation opening （ASITN grade 1-2） . Conclusions CT/TT type of MTHFR genotype is a risk factor for carotid stenosis. The collateral circulation of patients with CT/TT type is worse comparing with CC type in carotid stenosis. -
Key words:
- Carotid stenosis /
- MTHFR C677T gene polymorphism /
- Collateral circulation
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图 1 男性患者，58岁，左侧颈内动脉慢性闭塞
侧支循环代偿评估：后交通动脉开放，大脑后动脉通过后交通动脉向大脑前动脉供血区供血；大脑前动脉软膜支代偿大脑中动脉供血。 ASITN/SIR 分级2级。
Figure 1. male，58 years old， chronic left carotid artery occlusion. The collateral circulation assessment.
图 2 男性，52岁，左侧颈总动脉慢性闭塞，侧支循环代偿评估
前交通动脉开放，右侧大脑前动脉通过前交通动脉代偿左侧大脑前动脉、大脑中动脉供血区，ASITN/SIR 4级。
Figure 2. male，52 years old， chronic left carotid artery occlusion. The collateral circulation assessment.
图 3 女性，64岁， 左侧颈内动脉重度狭窄，侧支循环代偿评估
前交通动脉开放，右侧大脑前动脉通过前交通动脉代偿左侧大脑前动脉供血，ASITN/SIR 1级。
Figure 3. female，64 years old， severe left carotid stenosis. The collateral circulation assessment.
表 1 颈动脉狭窄及慢性闭塞组与对照组一般情况比较[n（%）]
Table 1. Comparison of the general conditions of patients with carotid stenosis or chronic occlusion [n（%）]
项目 颈动脉中重度狭窄及慢性闭塞（n = 65） 对照组（n = 45） t/χ2 P 性别 男 43（65.2） 25（55.6） 1.265 0.260 女 22（33.8） 20（44.4） 年龄（岁， $\bar x \pm s $） 68.81 ± 12.65 64.10 ± 8.16 −2.039 0.0445* 吸烟史 36（55.4） 16（35.6） 4.194 0.040* 饮酒史 22（33.8） 10（22.2） 1.741 0.187 高血压 48（73.8） 19（42.2） 11.168 0.008* 糖尿病 31（47.7） 13（28.9） 7.351 0.007* 缺血性心脏病 11（16.9） 6（13.3） 0.262 0.608 既往卒中史 51（78.5） 16（35.5） 20.559 < 0.001* TG（mmol/L， $\bar x \pm s $） 2.35 ± 0.53 2.11 ± 0.74 −1.791 0.077 TC（mmol/L， $\bar x \pm s $） 6.89 ± 1.86 3.85 ± 1.19 −8.967 < 0.001* HDL（mmol/L， $\bar x \pm s $） 0.96 ± 0.20 1.16 ± 0.56 1.728 0.191 LDL（mmol/L， $\bar x \pm s $） 2.98 ± 0.77 2.01 ± 0.75 −6.007 < 0.001* Hcy（umol/L， $\bar x \pm s $） 26.97 ± 9.14 15.13 ± 6.96 −6.769 < 0.001* CC基因型 27（41.5） 31（68.9） 7.98 0.0047* CT/TT基因型 38（58.5） 14（31.1） *P< 0.05。 
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表 2 慢性颈动脉闭塞侧支循环分级与MTHFR C677T 基因多态性关系[n（%）]
Table 2. Relationship between the grade of collateral circulation and MTHFR C677T gene polymorphism in patients with chronic carotid artery occlusion [n，（%）]
项目 n 慢性颈动脉闭塞侧支循环分级（n = 20） 4 级（n = 5） 3级（n = 9） 2级（n = 5） 1级（n = 1） CC 11 4（36.37） 6（54.55） 1（9.10） 0 TT/TC 9 1（11.11） 1（11.11） 6（66.67） 1（11.11） χ2 9.8413 P 0.02* 组间比较，*P< 0.05。
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表 3 中重度颈动脉狭窄侧支循环分级与MTHFR C677T 基因多态性关系[n（%）]
Table 3. Relationship between t the grade of collateral circulation and MTHFR C677T gene polymorphism in patients with moderate and severe carotid stenosis [n（%）]
项目 中重度颈动脉狭窄侧支循环分级（n = 45） 4 级（n = 6） 3级（n = 11） 2级（n = 20） 1级（n = 8） CC
（n= 16）4（25） 7（43.75） 4（25） 1（6.25） TT/TC
（n= 29）2（6.89） 4（13.79） 16（55.12） 7（24.14） χ2 10.288 P 0.016* 组间比较，*P< 0.05。
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[1] Abbott A L,Paraskevas K I,Kakkos S K,et al. Systematic review of guidelines for the management of asymptomatic and symptomatic carotid stenosis[J]. Stroke,2015,46(11):3288-3301. doi: 10.1161/STROKEAHA.115.003390 [2] Nakai K,Oyanagi M,Hitomi J,et al. Screening the Single Nucleotide Polymorphisms in Patients with Internal Carotid Artery Stenosis by Oligonucleotide-Based Custom DNA Array[J]. Bioinform Biol Insights,2009,1:63-69. [3] Marcucci R,Sofi F,Fedi S,et al. Thrombophilic risk factors in patients with severe carotid atherosclerosis[J]. J Thromb Haemost,2005,3(3):502-507. doi: 10.1111/j.1538-7836.2005.01173.x [4] 中国卒中学会脑血流与代谢分会. 缺血性卒中脑侧支循环评估与干预中国指南（2017）. 中华内科杂志, 2017, 56（6）: 460-471. [5] Verhoef P,Kok F J,Kluijtmans L A,et al. The 677C→T mutation in the methylenetetrahydrofolate reductase gene:associations with plasma total homocy steine levels and risk of co ronary atherosclerotic diease[J]. Athro sclerosis,1997,132(1):105-113. [6] 陈甲,和儒林,朗莹等. 中国人群MTHFR 基因C677T 多态性与青中年缺血性脑卒中相关性的Meta 分析[J]. 中国循证医学杂志,2014,14(4):435-442. doi: 10.7507/1672-2531.20140076 [7] 吴庆庆,马庆辉,梁健球. 亚甲基四氢叶酸还原酶C677T 基因多态性对老年高血压患者颈动脉粥样斑块形成的影响[J]. 广东医学,2014,35(3):374-376. [8] 朱武,张坤. 甲基四氢叶酸还原酶基因C677T多态性与高血压患者动脉粥样斑块形成的相关性[J]. 检验医学与临床,2016,13(13):1783-1785. doi: 10.3969/j.issn.1672-9455.2016.13.015 [9] Gecene M,Tuncay F,Borman P,et al. Atherosclerosis in male patients with ankylosing spondylitis:the relation with methylenetetrahydrofolate reductase (C677T) gene polymorphism and plasma homocysteine levels[J]. Rheumatol Int,2013,33(6):1519-1524. doi: 10.1007/s00296-012-2552-8 [10] Sun K,Song J,Liu K et al. Associations between homocysteine metabolism related SNPs and carotid intima-media thickness:a Chinese sib pair study[J]. J Thromb Thrombolysis,2017,43(3):401-410. doi: 10.1007/s11239-016-1449-x [11] Ruiz-Franco A,Barboza M A,Jara-Prado A,et al. TGFBR2 mutation and MTHFR-C677T polymorphism in a Mexican mestizo population with cervico-cerebral artery dissection[J]. J Neurol,2016,263(6):1066-1073. doi: 10.1007/s00415-016-8101-8 [12] 李振洲,肖亮,任力杰等. 颈动脉粥样硬化超声表现与同型半胱氨酸MTHFR基因多态性的相关性[J]. 中国医学影像技术,2013,29(8):1276-1279. [13] Tallarita T,Lanzino G,Rabinstein A A. Carotid intervention in acute stroke[J]. Perspect Vasc Surg Endovasc Ther,2010,22(1):49-57. doi: 10.1177/1531003510380469 [14] Guo J W,Wang B J. The research progress of the formation mechanism of collateral circulation[J]. Nerv Dis Mental Health,2009,9(2):177-179. [15] Henderson R D,Eliasziw M,Fox A J,et a1. Angiographically defined collateral circulation and risk of stroke in patients with severe carotid artery stenosis. North American Symptomatic Carotid Endarteretomy Trial ( NASCET ) Group[J]. Stroke,2000,3l(1):128-132. [16] Kim J J,Fischbein N J,Lu Y,et al. Regional angiographic grading system for collateral flow:correlation with cerebral infarction in patients with middle cerebral artery occlusion[J]. Stroke,2004,35(6):1340-1344. doi: 10.1161/01.STR.0000126043.83777.3a [17] 周浩, 魏守超, 赵兴军. 5, 10-亚甲基四氢叶酸还原酶基因多态性与脑梗死患者颈动脉粥样硬化的相关性研究. 中国卒中杂志, 2017, 12（1）: 23-28. [18] 黄海威,谭双全,付贤等. MTHFR基因多态性对血管内皮功能指标的影响[J]. 中国病理生理杂志,2008,24(10):1932-1936. doi: 10.3321/j.issn:1000-4718.2008.10.014 [19] Jcong S K,Kim D H,Cho Y I. Homocysteine and pulsatility index in lacunar infarction[J]. Clin Neurol Neurosurg,2011,113(6):459-463. doi: 10.1016/j.clineuro.2011.01.016 -
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