载脂蛋白E基因多态性检测对ACS患者降脂疗效的影响  

Effects of Apolipoprotein E Gene Polymorphism Detection on Lipid-lowering Efficacy in Patients with ACS

作　　者：伏开全 李群星 尹德录 王怡练[2] 邵泽波 宋洁 FU Kai-quan;LI Qun-xing;YIN De-lu;WANG Yi-lian;SHAO Ze-bo;SONG Jie(Department of Cardiology,Lianyungang Hospital Affiliated to Xuzhou Medical University,Lianyungang,Jiangsu,222020,China;Department of Cardiovascular Medicine,Lianyungang Second People's Hospital,Lianyungang,Jiangsu,222061,China;Ganyu District People's Hospital of Lianyungang City,Lianyungang,Jiangsu,222100,China)

机构地区：[1]徐州医科大学附属连云港医院心内科,江苏连云港222020 [2]连云港市第二人民医院心内科,江苏连云港222061 [3]江苏省连云港市赣榆区人民医院,江苏连云港222100

出　　处：《现代生物医学进展》2021年第6期1191-1195,共5页Progress in Modern Biomedicine

基　　金：江苏省六个一工程拔尖人才科研项目(LGY2017065)。

摘　　要：目的:探究载脂蛋白E(ApoE)基因多态性检测在急性冠脉综合征(ACS)患者降脂治疗的中应用价值。方法:选取2019年2月~2020年6月180例ACS患者,采用随机数字表法分为A、B、C共3组各60例,各组患者均接受ApoE基因多态性检测,并根据Sanger法测序判断ApoE基因表型(E2、E3、E4表型),A组予以瑞舒伐他汀口服(10 mg/d),B组予以瑞舒伐他汀强化治疗(20 mg/d),C组予以瑞舒伐他汀(10 mg/d)+依折麦布(10 mg/d)口服,连续治疗1个月,评价3组各基因表型血脂[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)]改善情况、LDL-C达标率,记录药物副反应,所有患者随访1个月,统计心血管不良事件(MACE)发生情况。结果:3组ApoE基因E2、E3、E4表型构成比无显著差异(P>0.05)。治疗后,各组不同ApoE基因表型TC、TG、LDL-C水平均较治疗前下降,且变化率比较差异有统计学意义(P<0.05),表现为E2型>E3型>E4型;其中,3组E2表型TC、TG、LDL-C水平变化率无显著差异(P>0.05);B组、C组E3表型TC、TG、LDL-C水平变化率均显著高于A组(P<0.05),但B组、C组各指标变化率比较差异无统计学意义(P>0.05);3组E4表型TC、TG、LDL-C水平变化率比较差异有统计学意义(P<0.05),且表现为C组>B组>A组。治疗后,A组LDL-C达标率为61.67%,显著低于B组的85.00%、C组的90.00%(P<0.05);其中,3组E2表型LDL-C达标率比较无显著差异(P>0.05),A组E3表型LDL-C达标率显著低于B组、C组(P<0.05),A组、B组E4表型LDL-C达标率低于C组(P<0.05)。治疗期间,仅B组出现1例ALT超出正常上限3倍,停药后可恢复正常。3组MACE发生率比较差异有统计学意义(P<0.05),表现为A组发生率18.33%明显高于B组5.00%、C组3.33%(P<0.05),但3组E2、E4型MACE发生率均无明显差异(P>0.05),而A组E3型MACE发生率高于B组、C组(P<0.05)。结论:ACS患者降脂疗效与ApoE基因表型有关,对E2表型单用瑞舒伐他汀即可取得良好降脂效果,对E3表型强化瑞舒伐他汀或联合依折麦Objective:To explore the application value of apolipoprotein E(ApoE)gene polymorphism detection in lipid-lowering therapy of patients with acute coronary syndrome(ACS).Methods:180 patients with ACS from February 2019 to June 2020 were selected,and they were divided into groups A,B and C by using random number table method,with 60 cases in each group.ApoE gene polymorphism was tested among all patients.According to the ApoE gene phenotypes(E2,E3,E4 phenotypes)determined by Sanger sequencing,group A was given oral administration of rosuvastatin(10 mg/d),and group B was given oral administration of rosuvastatin(20 mg/d),and group C was given oral administration of rosuvastatin(10 mg/d)+ezetimibe(10 mg/d).After 1 month of continuous treatment,the blood lipids[total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C)]and LDL-C compliance rate were evaluated among the three groups of phenotypes,and the medication side effects were recorded.All patients were followed up for 1 month,and the occurrence of major adverse cardiovascular events(MACE)were counted.Results:There were no statistically significant differences in the composition ratios of E2,E3,and E4 phenotypes of ApoE gene among the three groups(P>0.05).After treatment,the levels of TC,TG and LDL-C of different ApoE gene phenotypes in each group were decreased compared with those before treatment,and there were statistically significant differences in the change rates(P<0.05),manifested as E2 phenotype>E3 phenotype>E4 phenotype(P<0.05).There were no statistically significant differences in the change rates of TC,TG and LDL-C levels of E2 phenotype among the three groups(P>0.05).The change rates of TC,TG and LDL-C levels of E3 phenotype patients in groups B and C were significantly higher than those in group A(P<0.05),but there was no significant difference in the change rate of each index between group B and group C(P>0.05).There were statistically significant differences in the change rates of TC,TG and LDL-C levels of E4 phenotype pat

关 键 词：急性冠脉综合征 载脂蛋白E基因 瑞舒伐他汀 依折麦布 降脂疗效 心血管不良事件 

分 类 号：R541.4[医药卫生—心血管疾病]