遗传和环境因素对原发性高血压人群脑梗死发生的影响

Effects of genetic and environmental factors on the development of cerebral infarction in subjects with essential hypertension

目的 :评估血管紧张素 1型受体 (AT1 R) A/ C116 6多态性、纤溶酶原激活物抑制剂 - 1(PAI- 1) 4 G/ 5 G多态性和环境因素对原发性高血压 (EH)人群脑梗死 (CI)发生的影响。方法 :随机收集 2 40例神经内科 EH病例 ,根据有无 CI病史分为 CI组 (12 6例 )和非 CI组 (114例 )。采用等位基因特异性寡核苷酸探针杂交方法分析 AT1 R基因型 (AA、AC和 CC)和 PAI- 1基因型 (4G/ 4G、4G/ 5 G和 5 G/ 5 G)。通过多因素 L ogistic回归分析识别 EH人群CI发生的危险因素。结果 :AT1 R基因型与 EH人群 CI发生无显著性关系 ;CI与非 CI EH人群相比 ,PAI- 1基因型分布有显著性差异 ,前者 4G/ 4G基因型频率显著高于后者 ,然而 ,4G/ 4G基因型并非 CI独立危险因素 ;在 4G/4G基因型 ,甘油三酯 (TG)与 PAI- 1相关性最强 ;年龄≥ 70岁、糖尿病和血浆总胆固醇 (TC)水平≥ 5 .2 4mmol/ L是 3个独立的 CI危险因素 (OR值和 P值分别为 1.83和 0 .0 30 7,4.30和 0 .0 0 0 6 ,1.90和 0 .0 397)。结论 :AT1 R基因型对 CI发病不产生影响 ;PAI- 1基因型与 CI发生有关 ,但并非 CI独立危险因素 ;PAI- 14G/ 4G基因型可能协同 TG影响血浆 PAI- 1水平 ,促成 CI发生 ;年龄、糖尿病和血浆 TC水平是 EH人群发生 CI的独立预测因子。

Objective:To evaluate the influences of angiotensin II type l receptor (AT 1R) A/C 1166 polymorphism, plasminogen activator inhibitor 1(PAI 1) 4G/5G polymorphism and environmental factors on the development of cerebral infarction(CI) in population with essential hypertension (EH).Method:Based on the history of CI 240 patients with EH from the departments of neurology were divided into CI group (n=126) and non CI group (n=114). AT 1R genotypes(AA, AC and CC) and PAI 1 genotypes ( 4G/4G, 4G/5G and 5G/5G) were analyzed by the allele specific oligonucleotide hybridization technique. Multivariate Logistic regression analysis was performed to identify risk factors that might influence the occurrence of CI in patients with EH.Result:AT 1R genotypes were not significantly associated with CI in subjects with EH. There was a significant difference in PAI 1 genotypes distribution between the patients with CI and the patients without CI , with the 4G/4G genotype frequency in the former higher compared to that in the latter. However, 4G/4G genotype was not an independent risk factor for CI . Age≥70 years, diabetes mellitus and plasma total cholesterol levels≥ 5.24 mmol/L were three independent CI risk factors in patients with EH(respective odds ratios and p values: 1.83 and 0.030 7 , 4.30 and 0.000 6 , 1.90 and 0.039 7 ).Conclusion: AT 1R genotypes do not influence the occurrence of CI in EH. PAI 1 genotypes are related to the development of CI but not independent CI risk factors in EH. Age, diabetes mellitus and total cholesterol level are independent predictors for CI in population with EH.