新生儿重症监护病房早产儿血管紧张素转化酶水平变化及其与基因插入/缺失多态性的关系

Relationship between Serum Enzyme Activity and Angiotensin-Converting Enzyme Gene Insertion or Deletion Polymorphism of Preterm Infants in Neonatology Intensive Care Unit

目的检测新生儿重症监护病房早产儿血管紧张素转化酶(ACE)基因型、血清ACE水平在出生1周内的变化,探讨ACE基因插入/缺失多态性与血清ACE水平和病情变化的关系。方法早产儿85例,出生第3天取其末梢血提取DNA,确定ACE基因型,出生第1、3、7天分别采用紫外分光光度计法检测早产儿血清ACE水平,并进行危重病例评分。结果早产儿85例中,DD基因型19例,ID基因型34例,Ⅱ基因型32例。出生第1天DD基因型早产儿血清ACE水平[(33.42±7.93)U/L]显著高于Ⅱ基因型早产儿[(25.97±8.32)U/L](P<0.01),高于ID基因型早产儿[(31.53±7.56)U/L],但差异无统计学意义(P>0.05);ID基因型早产儿血清ACE水平显著高于Ⅱ基因型(P<0.01);在出生第3天和第7天,3种基因型早产儿血清ACE水平均逐渐下降,DD基因型早产儿高于ID基因型,二者显著高于Ⅱ基因型。出生第1天DD基因型的危重病评分[(87.37±8.30)分]低于ID基因型[(95.82±5.85)分]和Ⅱ基因型[(95.88±6.85)分],差异非常显著(Pa<0.01),ID和Ⅱ基因型间无差异;出生第3天,DD基因型的危重病评分[(92.95±7.10)分]显著低于ID基因型[(96.94±5.85)分],而与Ⅱ基因型[(96.44±6.87)分]无差异,ID和Ⅱ基因型间亦无差异;出生第7天,3种基因型间危重病评分均无差异。结论重症疾病时DD基因型携带者的病情相对重,血清ACE水平相对高,虽然疾病可能影响血清ACE水平,但是决定ACE水平的根本因素是个体间基因型的差异。

Objective To explore the relationship between angiotensin converting enzyme （ACE） gene insertion/deletion （I/D） polymorphism and serum ACE activity of preterm infants during the first week after birth in neonatology intersive care unit （NICU）. Methods ACE genotype was determined by genomic DNA which was isolated from heel - prick blood of 85 preterm infants. Serum ACE activity was measured on the first,third and 7^th day,and disease status of each infants were scored by the neonatal critical score on the first,third and 7^th day. Results DD genetype was in 19 cases,ID gene type was in 34 cases, Ⅱ gene type was in 32 cases. On the first day after birth,serum ACE activity of DD genotype[ （33.42 ±7.93 ） U/L] was higher than that of Ⅱ genotype [ （25.97 ±8.32） U/L] （P 〈 0.01 ）, there was no significance difference between DD and ID genotype[ （31.53±7.56 ）U/L] （P 〉 0.05 ）. On the third and 7^th day, serum ACE activity decreased among 3 genotypes, but with the highest in DD genotype and lowest in Ⅱ genotype. On the first day after birth, the critical score of DD genotype （87.37±8.30） was lower than that of 1D genotype （95.82±5.85 ） and Ⅱ genotype （95.88±6.85 ） （ Pa 〈 0.01 ）. On the third day, the critical score of DD genotype （ 92.95±7.10 ） was lower than that of ID genotype （96.94 ± 5.85 ）. On the 7^th day, there were no significant differences of critical score among 3 genotypes. Conclusions In critical cases, DD genotype carriers present more severe disease with higher serum ACE activity;although disease status can influence the serum ACE activity,it is determined by the ACE genotype.