血管紧张素转化酶基因多态性与β受体阻滞剂治疗慢性心力衰竭患者预后的关系

Relationship between the polymorphism of angiotensin-converting enzyme and the prognosis of chronic heart failure patients treated with beta-adrenergic receptor blockers

目的:探讨血管紧张素转化酶(ACE)基因多态性与β受体阻滞剂治疗心力衰竭患者预后的关系。方法:用聚合酶链式反应方法(PCR)检测432例收缩功能障碍性心力衰竭[左室射血分数(LVEF)<0.45]患者的ACE基因型,前瞻性随访所有患者(26.43±18.19)个月,随访终点是死亡。分析不同ACE I/D基因分型中β受体阻滞剂治疗与慢性心力衰竭患者生存率的关系。结果:ACED等位基因的生存率比Ⅰ等位基因明显降低(P=0.027);在ACEDD基因型中有β受体阻滞剂治疗组比无β受体阻滞剂治疗组的生存率明显增高(P=0.003);有β受体阻滞剂治疗组ACE II、ID、DD3种基因型的生存率无差异(P=0.196);无β受体阻滞剂治疗组ACEDD基因型的生存率比II、ID有明显降低的趋势,但无显著性差异(P=0.091)。结论:在慢性心力衰竭患者中,ACEDD基因型患者的生存率明显降低,β受体阻滞剂治疗效果与ACE I/D基因多态性有相关性,ACEDD基因型获益更大。

Objective：To evaluate the relationship between Angiotensin-Converting Enzyme（ACE） polymorphisms and the prognosis of chronic heart failure（CHF） patients treated with β-blockers.Method：ACE I/D gene polymorphisms in 432 CHF patients with systolic dysfunction（LVEF0.45） were detected by polymerase chain reaction（PCR）,and 26.43±18.19 months follow-up time were viewed to assess the end point of death in 432 CHD patients.At the same time,in different ACE I/D genotypes,relationships between the survival rate of CHF patients and β-blockers treatment were analyzed,too.Result：The survival of ACE D allele was significantly attenuated compared to Ⅰ allele（P=0.027）.In homozygous ACE DD patients,treatment with β-blocker was associated with a significant improvement in survival rate（P=0.003）.However,In other patients treated with β-blockers,no obvious improvement of survival rate was viewed in ACE Ⅱ、ID、DD genotype patients（P=0.196）.On the other hand,for patients without β-blockers treatment,there was a tendency of attenuation for survival rate in ACE DD not in ACE Ⅱ and ID patients,but with no statistical significance（P=0.091）.Conclusion：It shows that ACE DD genotype in CHF patients has significantly lower survival rate than in other genotype patients,which could be used as a predictive factor of prognosis for CHF patients,further,β-blocker therapy effects are related with ACE I/D gene polymorphisms,and β-blockers benefits ACE DD genotype patients most effectively.