急性缺血性卒中ApoEε4等位基因与血脂和预后相关性研究  

Association of ApoEε4 allele with blood lipid and prognosis in acute ischemic stroke patients

作　　者：张雅静[1] 石志鸿[1] 岳伟[1] 刘淑玲[1] 王晓丹[1] 刘梦圆[1] 管雅琳[1] 纪勇[1] 

机构地区：[1]天津市环湖医院神经内科,300060

出　　处：《中国现代神经疾病杂志》2015年第2期119-125,共7页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：天津市科技计划重点项目(项目编号:12ZCZDSY02900);天津市自然科学基金资助项目(项目编号:13JCYBJC21300)~~

摘　　要：目的探讨急性缺血性卒中患者载脂蛋白E(Apo E)ε4等位基因与血脂水平及预后的关系。方法据Apo E基因分型和美国国立卫生研究院卒中量表(NIHSS)评分,将786例急性缺血性卒中患者分为携带Apo Eε4等位基因组和不携带Apo Eε4等位基因组,以及预后良好组(NIHSS评分≤10分)和预后不良组(NIHSS评分>10分),分别采用单因素和前进法多因素Logistic回归分析筛查影响携带Apo Eε4等位基因急性缺血性卒中患者预后的不良因素。结果携带Apo Eε4等位基因组患者血清低密度脂蛋白胆固醇和载脂蛋白B表达水平高于不携带Apo Eε4等位基因组[(3.25±0.85)mmol/L对(3.00±0.83)mmol/L,P=0.008;(1.20±0.30)mmol/L对(1.09±0.25)mmol/L,P=0.000]。前进法多因素Logistic回归分析仅入院时NIHSS评分和出院时改良Rankin量表评分是影响急性缺血性卒中患者预后的主要危险因素(均P=0.000),而Apo Eε4等位基因并非其影响因素(P=0.343)。结论携带Apo Eε4等位基因的急性缺血性卒中患者血清低密度脂蛋白胆固醇和载脂蛋白B表达水平升高,但Apo Eε4等位基因并非预后不良的预测指标。Objective To explore the relationship between apolipoprotein E ε4 （ApoE84） allele and blood lipid, and the relationship between ApoE ε 4 allele and the prognosis of acute isehemic stroke. Methods The study included 786 patients with acute isehemie stroke admitted in Tianjin Huanhu Hospital from December 1, 2013 to June 30, 2014. The ApoE genotype was determined by polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP）. Total cholesterol （TC）, triglyeeride （TG）, low-density lipoprotein cholesterol （LDL-C）, high-density lipoprotein cholesterol （HDL-C）, ApoA, ApoB levels were also measured. The relationship between ApoE84 allele and blood lipid was analyzed. All patients were assessed by National Institute of Health Stroke Scale （NIHSS） on discharge, and they were divided into 2 groups according to NIHSS score： favorable prognosis group （NIHSS ≤10） and unfavorable prognosis group （NIHSS 〉 10）. The relationship between ApoEE4 allele and the outcome was analyzed by univariate and forward multivariate Logistic regression analysis. Results The ApoEε4 allele carriers had significantly higher LDL-C and ApoB levels than the non-ApoEε4 allele carriers [（3.25 ± 0.85） mmol/L vs （3.00 ± 0.83） mmol/L, P = 0.008; （1.20 ± 0.30） mmol/L vs （1.09 ± 0.25） mmol/L, P = 0.000]. Forward multivariate Logistic regression analysis showed NIHSS score on admission and modified Rankin Scale （mRS） on discharge were the major influencing factors for prognosis of acute ischemic stroke （P = 0.000, for all）. The ApoE64 had no significant outstanding influence on the outcome of acute ischemic stroke （P = 0.343）. Conclusions The presence of ApoE84 allele do not predict a worse outcome of acute ischemic stroke, but it is associated with increased LDL-C and ApoB in acute ischemic stroke.

关 键 词：脑缺血 载脂蛋白E类 等位基因 预后 危险因素 回归分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]