血管紧张素转化酶基因多态性与急性前壁心梗后左室重塑及预后的相关性研究  

Relationship between ACE gene polymorphism and left ventricular remodeling and prognosis in patient with acute anterior myocardial infarction

作　　者：曾诚 郭晓玲[1] 任晓兰[1] 段霄燕 

机构地区：[1]武警四川总队成都医院内一科,四川省成都市610041

出　　处：《中国心血管病研究》2017年第9期796-800,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨血管紧张素转化酶（ACE）基因多态性与急性前壁心梗后患者左心室重塑及预后的关系.方法 选取164例急性前壁心肌梗死（AMI）患者作为研究对象.超声检测患者左心室收缩末期内径（LVSD）、左心室舒张末期内径（LVDD）、左室射血分数（LVEF）、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、心肌做功指数（MPI）等指标.提取所有患者外周血DNA,多聚酶链反应检测ACE插入（Ⅰ）/缺失（D）多态性.对所有患者随访1年,记录主要心血管事件（MACE）发生情况;比较不同ACE基因型与左室重塑及1年内MACE发生频率的关系.结果 164例AMI患者ACE基因Ⅰ/Ⅰ型80例、D/D型67例、Ⅰ/D型17例,分布频率分别为48.8％、40.8％、10.4％.第7天时,三组患者MPI、LVEDV、LVESV和LVSD差异有统计学意义（P＜0.05）.D/D基因型组患者第7天MPI、LVESV、LVDD较第1天时显著下降,而LVEDV、LVEF较第1天显著升高（P＜0.05）.Ⅰ/D基因型组患者第7天MPI和LVEF与第1天时差异具有统计学意义（P＜0.05）.D/D基因型组患者第7天MPI显著低于其余两组（P＜0.05）.而D/D基因型组患者第7天LVEDV显著低于Ⅰ/D组（P＜0.05）,与Ⅰ/Ⅰ组未见统计学差异（P＞0.05）.Ⅰ/D基因型患者第7天LVESV和LVSD显著高于其余两组（P＜0.05）.D/D基因型患者发生MACE的风险显著增加,其OR值为17.16,而Ⅰ/Ⅰ基因型患者发生MACE的风险显著下降,其OR值仅为0.39（P＜0.05）.结论 ACE基因多态性可能会影响早期心肌梗死后重塑,而D/D型更易发生左室重塑并且1年内发生MACE的风险显著高于其余两种基因型.Objective To analyze the relationship between angiotensin converting enzyme （ACE） gene polymorphism and left ventricular remodeling and prognosis in patient with acute anterior myocardial infarction.Methods 164 cases of acute anterior myocardial infarction（AMI） were selected as research subjects.Left ventricular systolic diameter （LVSD）,left ventricular end-diastolic diameter （LVDD）,left ventricular ejection fraction （LVEF）,left ventricular end-diastolic volume（LVEDV）,left ventricular end-systolic volume（LVESV）,myocardial acting Index （MPI） and other indicators were detected by ultrasonic.The peripheral blood DNA of all patients were extract,and the ACE insertion（Ⅰ）/deletion（D） polymorphism was detected by polymerase chain reaction.All patients were followed up for 1 year,the major cardiovascular events（MACE） occurrence were recorded.The relationship between different ACE genotypes and frequency of left ventricular remodeling and MACE was analyzed.Results In the 164 cases of AMI,patients with ACE gene Ⅰ/Ⅰ type was 80 cases,D/D type was 67 cases,Ⅰ/D type was 17 cases,the distribution frequency was of 48.8%,40.8% and 10.4% respectively.At 7th day,the MPI,LYEDV,LVESV and LVSD of three groups have significant difference （P〈0.05）.MPI,LVESV,LVDD of patients with D/D genotype were decreased than the first day,while LVEDV,LVEF were significantly increased compared to day 1 （P〈0.05）.MPI and LYEF in patients with Ⅰ/D genotype between first day and seventh day were different statistically （P〈0.05）.The MPI was significantly lower in the D/D genotype group than in the other two groups at seventh day （P〈0.05）.The LVEDV was significantly lower in the D/D genotype group than in the Ⅰ/D group at seventh day （P〈0.05）.There was no significant difference between the Ⅰ/Ⅰ group and the Ⅰ/Ⅰ group in LVEDV at seventh day（P〉0.05）.Ⅰ/D genotype had significantly higher LVESV and LVSD on the seventh day than the other two groups （P〈0.05

关 键 词：血管紧张素转化酶 心肌梗死 左室重塑 多态性 

分 类 号：R542.22[医药卫生—心血管疾病]