氨氯地平逆转颈动脉内中膜增厚作用与血管紧张素转换酶基因型的相关性

The relationship between the effect of amlodipine on carotid infimal-mediai thickness and angiotensin converting enzyme genotypes in elderly hypertensive patients

目的探讨氨氯地平的抗颈动脉粥样硬化作用与老年高血压病患者血管紧张素转换酶（ACE）基因多态性的关系。方法220例老年高血压病患者服用氨氯地平2．5～10．0mg，每日1次，共12个月。将资料完整的208例患者按基因型分为II型、ID型、DD型三组，比较不同基因型组间及各基因型组在治疗前、后的颈动脉参数变化。结果三组患者的平均颈动脉内一中膜厚度（MIMT）治疗后与治疗前比较均有下降，但仅在II组差异有统计学意义（0．96±0．12对0．92±0．13，P〈0．01），II组与ID、DD组比较，下降幅度（AMIMT）大，差异具有统计学意义（P〈0．01）；II组的斑块积分治疗后与治疗前比较有下降（4．85±2，51对3．90±2．36，P〈0．05）。多元线性回归结果表明，II基因型、治疗前后收缩压差值（ASBP）和治疗前收缩压水平是影响AMIMT值的主要因素。结论氨氯地平的抗颈动脉粥样硬化作用在不同ACE基因型的老年高血压病患者间存在差异，II基因型患者获益最大。

Objective To investigate the association between the anti-atherosclerotic effects of amlodipine and angiotensin converting enzyme （ACE） gene insertion/deletion （I/D） polymorphism in elderly essential hypertensive （EH） patients. Methods A total of 220 EH patients were treated with amlodipine （2.5 - 10 mg, once daily） for twelve months and complete data were obtained from 208 patients with genotypes of II （ n = 90 ） , ID （ n = 91 ） and DD （ n = 27 ）. The indices of carotid arterial were compared before and post amlodipine treatment in patients with identical genotype and among different ACE genotypes and each genotype post therapy. Results The carotid mean intimal-medial thickness （MIMT） was slightly decreased in EH patients with ID and DD genotypes and significantly decreased in EH patients with II genotype （0.96 ± 0. 12 vs. 0.92 ± 0. 13,P 〈 0.01 ） compared to pre-treatment values. The decreased degree of MIMT （AMIMT） in II genotype was significantly higher in II genotype than those in ID or DD genotype （0.05 ± 0.03 vs. 0.01 ± 0.02,0.01 ± 0.03 respectively, P 〈 0.01 ）. The post treatment plaque score （PS） in patients with II genotype was significantly reduced （4. 85 ± 2. 51 vs. 3. 90 ± 2. 36, P 〈 0.05 ）. Multivariate linear regression analysis showed the baseline SBP , the decreased degree of SBP （ASBP） and the II genotype were the major factors affecting the AMIMT. Conclusion Hypertensive patients carrying II genotype ACE genotype are the best responders for the anti-atberosclerotic effects of amlodiping.