血管紧张素转换酶基因多态性与高血压左室肥厚的关系

The relationship between the polymorphism of the ACE gene and left ventricular hypertrophy in hypertensive subjects

目的探讨血管紧张素转换酶（ＡＣＥ）基因多态性与高血压左室肥厚的关系。方法对１０４例高血压病患者，采用二维引导下的Ｍ型超声心动图检测有无左室肥厚（ＬＶＨ），同时作２４小时动态血压监测，采血检测ＡＣＥ基因多态性（ＰＣＲ方法）。１１３例正常人作基因频率检测。结果（１）高血压ＬＶＨ（＋）与ＬＶＨ（－）两组动态血压指标除夜间平均ＳＢＰ、平均动脉压（ＭＡＰ）差异有显著性外，２４小时及白天平均ＳＢＰ、ＤＢＰ、ＭＡＰ和夜间平均ＤＢＰ两组间差异均无显著性。（２）ＬＶＨ（＋）组Ｉ基因频率明显高于ＬＶＨ（－）组，ＬＶＨ（＋）组Ｉ基因型明显高于ＬＶＨ（－）组。（３）１１３例正常人基因型频率分布：Ｉ为０．５８，Ｄ为０．４２。结论本研究提示，ＡＣＥ基因多态性与左室肥厚明显相关，Ｉ基因型者似更易发生左室肥厚。ＡＣＥ基因型频率分布东方人与西方人不同。

Objective Left ventricular hypertrophy (LVH) is a major independent risk factor for morbidity and mortality of cardiovascular disease. Studies suggest that angiotensin II may stimulate cardiac protein synthesis, whereas bradykinin may have an antiproliferative effect. Angiotensin converting enzyme (ACE) is a key enzyme in the production of angiotensin II as well as the degradation of bradykinin and thus may participate in the modulation of cardiac growth. In humans, the ACE levels are determined genetically. In the present study, we examined possibility that the genotypes of the ACE gene might influence the development of LVH in hypertensive subjects. Methods The study population consisted of 104 hypertensives with LVH or without LVH and 113 normal subjects. LVH was calculated from two dimensionally guided M mode echocardiographic measurements. The hypertensive subjects were monitored by ambulatory blood pressure monitoring (ABPM). The genotypes of the ACE gene was determined by the polymerase chain reaction (PCR). Results (1) ABPM: No significant differences in mean levels of SBP, DBP, and MAP of 24 hours and daytime and mean levels of DBP of nighttime between LVH (+) and LVH (-), but mean levels of SBP, MAP of nighttime. (2) The frequency of the I allele was higher in the group of LVH(+) than in the group of LVH (-), the genotype of II was higher in the group of LVH(+) than in the group of LVH (-). (3) I allele frequences were 0.58 and D allele frequences were 0.42 in 113 normal subjects. Conclusions A significant relationship has been found between the polymorphism of the ACE gene and LVH, the II genotype seems to predispose to LVH. The different frequencies of the ACE genotypes have been found between the East and the West.