背景:支架再狭窄在接受经皮冠状动脉介入治疗(PCI)的冠心病患者中是一种相对常见的现象。似乎一套临床,实验室,甚至遗传因素也使人们容易受到这种现象的影响,事实上,这是多因素的。我们的目标是首先确定潜在的临床和实验室危险因素的基础上,PCI后支架再狭窄的发生基于系统评价研究。之后,通过一项生物信息学研究,评价支架再狭窄发生的相关基因和microRNAs。
方法:第一步,包括Medline在内的手稿数据库,WebofKnowledge,谷歌学者,Scopus,和Cochrane在所有符合条件的研究中进行了深入搜索,这些研究基于考虑的关键词,介绍了支架再狭窄的临床和实验室决定因素.在生物信息学阶段,并回顾了文献以鉴定与再狭窄有关的基因和microRNAs,通过GeneMANIA网络分析和Cytoscape软件确定每个基因与支架再狭窄相关的其他基因的相互作用.总的来说,关于支架再狭窄的临床和生化预测因素的67篇文章(包括40,789例患者)和关于该事件的遗传决定因素的25篇文章符合最终分析的条件。该事件的预测因素分为四个亚组,基于患者的参数,包括传统的心血管风险概况。基于支架的参数,包括所用支架的类型和直径特征,基于冠状动脉病变的参数,包括几个两个靶病变和冠状动脉受累严重程度,以及与炎症过程激活特别相关的实验室参数。在生物信息学阶段,考虑到编码炎性细胞因子的基因的特殊位置,我们发现了42个被描述参与这种现象的基因。此外,已经指出12个microRNA涉及靶向涉及支架再狭窄的基因。
结论:支架再狭窄的发生率是临床危险因素复杂相互作用的结果,实验室因素主要与炎症过程的激活有关,和复杂的基因间相互作用网络。
BACKGROUND: Stent restenosis is a relatively common phenomenon among patients with coronary heart disease undergoing percutaneous coronary intervention (PCI). It seems that a set of clinical, laboratory, and even genetic factors make people susceptible to such a phenomenon and in fact, this is multi-factorial. We aimed to first determine the underlying clinical and laboratory risk factors for the occurrence of stent re-stenosis after PCI based on a systematic
review study, and after that, through a bioinformatics study, to evaluate the related genes and microRNAs with the occurrence of stent re-stenosis.
METHODS: In the first step, the manuscript databases including Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane were deeply searched by the two blinded investigators for all eligible studies based on the considered keywords to introduce clinical and laboratory determinants of stent re-stenosis. In the bioinformatic phase, and following a
review of the literature to identify genes and microRNAs involved in restenosis, the interaction of each gene with other genes associated with stent re-stenosis was determined by GeneMANIA network analysis and Cytoscape software. Overall, 67 articles (including 40,789 patients) on clinical and biochemical predictors for stent restenosis and 25 articles on genetic determinants of this event were eligible for the final analysis. The predictors for this event were categorized into four subgroups patient-based parameters including traditional cardiovascular risk profiles, stent-based parameters including type and diametric characteristics of the stents used, coronary lesion-based parameters including several two target lesions and coronary involvement severity and laboratory-based parameters particularly related to activation of inflammatory processes. In the bioinformatic phase, we uncovered 42 genes that have been described to be involved in such a phenomenon considering a special position for genes encoding inflammatory cytokines. Also, 12 microRNAs have been pointed to be involved in targeting genes involved in stent re-stenosis.
CONCLUSIONS: The incidence of stent re-stenosis will be the result of a complex interaction of clinical risk factors, laboratory factors mostly related to the activation of inflammatory processes, and a complex network of gene-to-gene interactions.