载脂蛋白E基因多态性对高血压脑出血发病的影响

Influence of apolipoprotein E polymorphism in onset of hypertensive intracerebral hemorrhage

目的了解载脂蛋白E（APOE）基因多态性与高血压脑出血（HICH）发病的关系。方法设计对照研究，对川北医学院附属医院神经外科自2007年9月至2010年12月收治的128例HICH患者（HICH组）及84例正常成人（对照组）采用聚合酶链反应限制性片段长度多态性法（PCR—RFLP）检测APOE基因型，比较2组对象APOE基因型及等位基因频率的差异，并进一步比较不同APOE基因型患者发病年龄、性别、血压、血脂、出血部位、血肿大小等因素的差异。结果HICH组有吸烟嗜好、糖尿病史的比例以及总胆固醇（TC）、低密度脂蛋白（LDL-C）浓度均明显高于对照组，差异有统计学意义（P〈0．05）。HICH组APOEe3／4基因型及APOEg4等位基因的分布频率明显高于对照组，而APOEs3／3基因型、APOE63等位基因的分布频率明显低于对照组，差异有统计学意义（氏0．05）。HICH组中APOEs3／4基因型及APOE^4等位基因携带者的发病年龄≤45岁和浅部出血的比例以及LDL—C及TC血浆浓度均明显高于APOEe3／3基因型及APOEe3等位基因携带者，发病时收缩压明显低于APOEe3／3基因型及APOEe3等位基因携带者，差异均有统计学意义（P〈0．05）。结论APOE基因多态性对HICH的发生有重要影响，影响因素包括发病年龄、血压、血脂以及出血的部位，其机制可能与影响动脉粥样硬化和血管淀粉样变有关。

Objective To investigate the relationship between apolipoprotein E （APOE） genotype and onset of hypertensive intracerebral hemorrhage （HICH）. Methods One hundred and twenty-eight patients with HICH, admitted to our hospital from September 2007 to December 2010, and 84 healthy controls clinically free from neurology disease were chosen in our study. APOE genotype was determined using polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP）; the distribution ofAPOE genotype and allele frequency between the 2 groups were compared; the age of onset, gender, blood pressure, blood fat, bleeding part and size of haematoma in patients with different APOE genotype were further studied. Results The subjects with smoking hobby, diabetes history and higher concentrations of TC and LDL-C in the HICH group were obviously more than those in the control group （P〈0.05）. As compared with those in the controls, the distributions of the A POEε3/4 and A POEε4 in the HICH group were significantly higher, and the distributions of the APOEε3/3 and APOEε3 in the HICH group were significantly lower （P〈0.05）. The APOEε3/4 and APOEε4 carriers enjoyed higher percentages of onset age less than 45 years and superficial haematoma than APOEε3/3 and the APOEε3 carriers. The onset systolic blood pressure in A POEε3/4 and A POEε4 carriers was obviously lower than that in APOEε3/3 and APOEv3 carriers （P〈0.05）. The plasma concentrations of LDL-C and TC in APOEe,3/4 and APOEε4 carriers was significantly higher than those in APOEε3/3 and APOEε3 carriers（P〈0.05）. Conclusion The APOE genotype influences the onset of HICH, and its influence factors included onset age, blood pressure, blood fat and bleeding part, which may concern with the cerebral artherosclerosis or amyloidosis .