苯那普利治疗肝硬化腹水的疗效及其与血管紧张素转化酶基因多态性的关系

Relationship between polymorphism of ACE and the curative effect of ACEI to ascites of liver cirrhosis

目的:观察血管紧张素转化酶抑制剂(ACEI)对肝硬化腹水的疗效,并探讨ACE基因多态性与ACEI疗效的相关性。方法:选择68例肝硬化腹水患者,随机分为2组,对照组给予限制钠水摄入、保肝、利尿和补充白蛋白等常规治疗,治疗组在此基础上加用苯那普利12.5～25mg,qd。所有病例均完成4周疗程。应用聚合酶链式反应-限制性片段长度多态性(PCR-RFLP)方法检测ACE基因插入/缺失(Insertion/Deletion,I/D)多态性。结果:苯那普利治疗组疗效显著者为70.6%,对照组为44.4%,差异有显著性(P<0.05)。治疗组24h尿钠及尿量较对照组有明显增加(P<0.05),治疗组和对照组平均腹水消退时间分别为(33±8.6),(45.2±10.6)d,差异具有显著性(P<0.05)。苯那普利治疗有效组ACE(I/D)DD基因型频率为0.46,明显高于苯那普利治疗无效组的0.10(P<0.05),DD基因型患者的治疗有效率(91.7%)明显高于II基因型(53.3%)(P<0.01)。结论:加用苯那普利治疗肝硬化腹水,有助于降低门脉压力、促进腹水消退,缩短腹水消退时间;ACE基因多态性对于肝硬化腹水ACEI的疗效判定有一定指导意义。

OBJECTIVE To observe the curative effect of ACEI on ascites of liver cirrhosis and to discuss the relationship between polymorphism in ACE gene and the curative effect of ACEI. METHODS Sixty-eight patients with ascites of liver cirrhosis were included randomly and were divided into two groups. In control group the patients were treated routinely such as liver-protection, diuresis and so on, in treatment group the patients were treated additionally with benazapril 12. 5 - 25 mg once daily. The period of treatment for all patients was four weeks. ACE polymorphism was detected by PCR-RFLP. RESULTS The effective rate of treatment group was 70. 6 %, that of control group was 44.4 %, the difference between the treatment group and the control group was significant（P〈0. 05）. The 24 hours urine sodium and urine amount of treatment group was significantly increased than that of control group. The ascitesfade time of treatment group was （33± 8. 6） days and that of control group was （45.2 ± 10. 6） days, the difference between two groups was significant （P〈0. 05）. The frequency of DD genotype in benazapril effective group was 0. 46 and that in benazapfil ineffective group was 0. 10, the difference was significant （P〈 0. 05）. The effective rate of DD genotype was 91.7%, that of DI genotype was 71.4%, that of Ⅱ genotype was 53.3%, and the effective rate of DD genotype was significantly higher thanⅡgenotype （P〈0. 05）. CONCLUSION Adding benazapril to the treatment of ascites of liver cirrhosis can reduce the pressure of portal vein, accelerate the fadeaway of ascites, shorten the ascites-fade time. The polymorphism of ACE（I/D） is helpful for the diagnosis of the therapeutic efficacy of ACEI in ascites of liver cirrhosis.