2型糖尿病患者载脂蛋白E基因多态性与心肌梗死的相关性  

Association between apolipoprotein E polymorphism and myocardial infarction in patients with type 2 diabetes mellitus

作　　者：马亮[1] 袁源 姜永玮[1] 孔晓牧[1] 牛文全 丛笑[1] 刘怡 赵美美 高芃 姚树坤[4] 曹永彤[1] Ma Liang;Yuan Yuan;Jiang Yongwei;Kong Xiaomu;Niu Wenquan;Cong Xiao;Liu Yi;Zhao Meimei;Gao Peng;Yao Shukun;Cao Yongtong(Department of Clinical Laboratory,China-Japan Friendship Hospital,Beijing 100029,China;International Medical Department,China-Japan Friendship Hospital,Beijing 100029,China;BioBank Center,Institute of Clinical Medical Science,China-Japan Friendship Hospital,Beijing 100029,China;Department of Gastroenterology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院检验科,北京100029 [2]中日友好医院国际部,北京100029 [3]中日友好医院临床医学研究所生物样本库,北京100029 [4]中日友好医院消化科,北京100029

出　　处：《中华检验医学杂志》2021年第10期926-930,共5页Chinese Journal of Laboratory Medicine

基　　金：国家重点研发计划精准医学研究重点专项(2017YFC0910002);国家自然科学基金(82074221);北京临床重点专科项目(2020年度)。

摘　　要：目的探讨2型糖尿病患者(T2DM)载脂蛋白E(apoE)E2、E4等位基因与心肌梗死(MI)的相关性,分析apoE基因多态性与血脂代谢指标的关系。方法采用病例对照研究方法,收集2016年8月至2020年3月中日友好医院T2DM住院患者3 459例,其中无MI患者3 044例(T2DM组),MI患者415例(T2DM+MI组)。采用实时荧光定量PCR技术检测apoE基因多态性,采用全自动生化分析仪检测血脂水平。采用Logistic回归分析确定apoE基因对T2DM患者MI患病风险的影响。结果 (1)apoE基因的等位基因频率比较:T2DM+MI组E4等位基因频率(12.29%,102/830)高于T2DM组(9.13%,556/6 088),E2等位基因频率(7.35%,61/830)低于T2DM组(8.21%,500/6 088)(P=0.012);Logistic回归分析结果显示携带E4等位基因(E3/E4+E4/E4)是T2DM进展为MI的风险因素(OR=1.48,95%CI 1.14~1.92,P=0.003)。携带E2等位基因(E2/E3+E2/E2)与T2DM进展为MI无关(OR=0.88,P=0.642)。(2)apoE基因多态性与血脂水平:TC、LDL-C和apoB水平在携带E4等位基因、野生型和携带E2等位基因患者依次增高,差异有统计学意义(P<0.05);HDL-C、apoA1和apoE水平在携带E4等位基因、野生型、携带E2等位基因患者依次减低,差异有统计学意义(P<0.05)。结论携带E4等位基因是T2DM患者发生MI的风险因素;apoE基因多态性可以影响血脂水平。Objective To investigate the relationship between the E2 and E4 alleles of apolipoprotein E(apoE)gene and myocardial infarction(MI)in type 2 diabetes Mellitus(T2DM)patients,and to explore the relationship between apoE polymorphism and blood lipid metabolism.Methods This case control study was conducted from August 2016 to March 2020 in China-Japan Friendship Hospital,3459 inpatients with T2DM were included including 3044 patients without MI(T2DM group)and 415 patients with MI(T2DM+MI group).Real time fluorescent quantitative PCR was used to detect apoE polymorphism.Automatic biochemical analyzer was used to detect lipid levels.Logistic regression analyses were performed to determine the association of apoE with risk of MI in patients with T2DM.Results(1)The frequency of E4 allele in T2DM+MI group(12.29%,102/830)was significantly higher than in T2DM group(9.13%,556/6088),while the frequency of E2 allele in T2DM+MI group(7.35%,61/830)was significantly lower than that in T2DM group(8.21%,500/6088),P=0.012.Logistic regression analyses showed that E4 allele carrier(E3/E4+E4/E4)faced a higher risk for MI in T2DM patients(OR=1.48,95%CI 1.14-1.92,P=0.003),while E2 allele carrier(E2/E3+E2/E2)did not face a higher risk of MI in T2DM patients(OR=0.88,P=0.642).(2)The levels of apoE polymorphism and blood lipid:The levels of TC,LDL-C and apoB increased in the order of E4 allele,wild type and E2 allele(P<0.05).The levels of HDL-C,apoA1 and apoE decreased in the order of E4 allele,Wild type and E2 allele(P<0.05).Conclusion The E4 allele is a risk factor for MI in T2DM patients,and apoE polymorphism can affect blood lipid level in this patent cohort.

关 键 词：心肌梗死 载脂蛋白E类 多态性 单核苷酸 糖尿病 

分 类 号：R542.22[医药卫生—心血管疾病] R587.1[医药卫生—内科学]