血管紧张素Ⅰ转换酶基因多态性与急性脑血管病的关系

Angiotensin converting enzyme gene polymorphism and cerebrovascular disease

目的研究血管紧张素转换酶（ＡＣＥ）基因多态性和急性脑血管病（ＡＣＶＤ）的发病关系。方法应用ＰＣＲ方法检测１５０例ＡＣＶＤ患者和１１７名正常人ＡＣＥ基因的缺失／插入多态性，同时测定血浆血管紧张素ＩＩ（ＡｎｇＩ）水平。结果ＡＣＶＤ患者的ＡＣＥ基因型及等位基因频率和正常对照组比较差异无显著意义，脑卒中和高血压家族史阳性患者的ＤＤ型及Ｄ等位基因频率明显高于阴性家族史的患者。ＡＣＶＤ患者血浆ＡｎｇＩＩ水平显著高于正常对照，ＤＤ型患者的血浆ＡｎｇＩ水平明显高于ＩＩ型患者，ＡｎｇＩ水平随出血量及梗死范围增大而升高，死亡患者ＡｎｇＩＩ水平显著高于存活组。结论有脑卒中和高血压家族史的ＤＤ型ＡＣＥ基因携带者具有卒中易感性，在这些人群中进行ＡＣＥ基因调查有助于脑血管病的防治。血浆ＡｎｇＩＩ水平还可作为判断病情预后的一项临床指标。

Objective The purpose of the study was to investigate the relationship between the polymorphism of the angiotensin converting enzyme(ACE) gene and the coming on of acute cerebrovascular disease. Method An insertion/deletion polymorphism of the ACE gene was analysed by polymerase chain reaction and plasma angiotensinII levels were determined in 150 cases of stroke and 117 control subjects. Results No difference in genotype and allele gene frequency was observed between the patients with stroke and the control subjects and also between the control subjects and the patients with cerebral hemorrhage or with cerebral infarction. The frequency of the DD genotype of the ACE gene was significantly higher in the patients with the family history of stroke or hypertension (0.24 and 0.44) than in the patients without the family history of stroke or hypertension(0.20 and 0.17)(χ 2=9.61 and 14.58, P <0.01).The frequency of the D allele was also significantly higher in the patients with than in those without the family history of stroke or hypertension(0.51 and 0.66 vs 0.35 and 0.34, χ 2=6.20, P <0.05 and χ 2=18.53, P <0.01).The levels of the plasma angiotensin II were significantly higher in the patiens with stroke than in the control subjects (104±31 ng/L vs 90±12ng/L, P <0.01). Besides, the DD genotype of the ACE gene was associated with the higher concentrations of plasma angiotensin II. Conclusion These suggested that the DD genotype increased riske of stroke in the subjects who had the family history of stroke or hypertension and investigation of ACE genotype among these persons might be of help for prevention of stroke.The level of plasma angiotensin II was related to the prognosis of stroke.