他汀类药物代谢相关ApoE基因多态性与冠状动脉介入术后再狭窄的相关性研究  

Correlation between ApoE gene polymorphism related to statins metabolism and postoperative restenosis after percutaneous coronary intervention

作　　者：范春煜[1] 苏昊[1] 付强[1] 苏琦[1] 夏霏[1] 刘海涛[1] Fan Chunyu;Su Hao;Fu Qiang;Su Qi;Xia Fei;Liu Haitao(Department of Cardiovascular Medicine,People's Hospital of Liaoning Province,Shenyang 110000,China.)

机构地区：[1]辽宁省人民医院心血管内科,沈阳110000

出　　处：《中国循证心血管医学杂志》2020年第6期703-707,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：辽宁省自然科学基金计划重点项目(20180530004)。

摘　　要：目的 讨论载脂蛋白E(ApoE)基因多态性对他汀类药物降脂疗效的影响以及与经皮冠状动脉介入术(PCI)后发生支架内再狭窄(ISR)的相关性.方法 选取2016年1月至2018年5月期间于辽宁省人民医院心血管内科行PCI术的615例患者为研究对象,根据术后随访1年后行冠状动脉(冠脉)造影复查结果,将患者分为ISR组和非ISR组.比较两组患者的一般临床资料、血液生化指标以及ApoE基因代谢表型携带率;采用二分类Logistic回归模型分析影响ISR发生的危险因素.结果 随访1年后72例发生ISR543例患者未发生ISR.ISR组患者血清低密度脂蛋白胆固醇(LDL-C)水平以及糖尿病史和高脂血症病史比例高于非ISR组患者(P<0.05).另外,ISR组有13例患者(18.1%)为慢代谢型,慢代谢型患者比例明显高于非ISR组(5.0%)(P<0.05).所有患者服用阿托伐他汀钙12 w后,复查血脂指标.所有患者TG、TC和LDL-C较基线值均有不同程度的下降,而慢代谢型患者TC和LDL-C下降幅度较快代谢型和正常代谢型患者更低(P<0.05).另外,快代谢型患者三酰甘油(TG)、总胆固醇(TC)和LDL-C下降幅度与正常代谢型患者比较未见统计学差异(P>0.05).经二分类Logistic回归分析,快代谢型和正常代谢型是ISR的独立保护因素,且快代谢型的危险性低于正常代谢型.结论 APoE基因多态性与他汀类药物降脂疗效有关,且对PCI术后再狭窄有一定影响.Objective To discuss the influence of gene polymorphism of apolipoprotein E(ApoE)on the lipid-lowering effect of statins,and correlation between ApoE gene polymorphism and in-stent restenosis(ISR)after PCI.Methods The patients undergone PCI(n=615)were chosen from Department of Cardiovascular Medicine in People’s Hospital of Liaoning Province from Jan.2016 to May 2018,and then divided,according to outcomes of coronary angiography(CAG)after PCI and followed up for 1 y,into ISR group and non-ISR group.The general clinical materials,blood biochemical indexes and carrying rate of ApoE metabolic phenotype were compared between 2 groups.The risk factors of ISR were analyzed by using binary Logistics regression analysis.Results After followed up for 1 y,there were 72 cases of ISR in ISR group and 543 in non-ISR group.The level of LDL-C and percentages of patients with diabetes history and hyperlipidemia history were higher in ISR group than those in non-ISR group(P<0.05).There were 13 patients(18.1%)with low metabolism in ISR group,and the percentage of patients with poor metabolism was more than that in non-ISR group(5.0%,P<0.05).All patients were re-examined blood fat indexes after took atorvastatin calcium for 12 weeks.The levels of TG,TC and LDL-C decreased in varying degrees compared with baseline value in all patients,and levels of TC and LDL-C were lower in patients with poor metabolism than those in patients with extensive or normal metabolism(P<0.05).The descend range of levels of TG,TC and LDL-C had no statistical difference between patients with extensive metabolism and those with normal metabolism(P>0.05).The results of binary Logistics regression analysis showed that extensive metabolism and normal metabolism were independent protective factors of ISR,and risk of extensive metabolism was lower than that of normal metabolism.Conclusion The gene polymorphism of APoE is correlated to the lipid-lowering effect of statins,and has certain influence on restenosis after PCI.

关 键 词：冠心病 经皮冠状动脉介入 他汀类药物 APOE基因 支架内再狭窄 

分 类 号：R816.2[医药卫生—放射医学]