血压波动及血管紧张素原M235T基因多态性与皮层下动脉硬化性脑病相关性研究

Relationship of blood pressure variability and angiotensinogen T235M polymorphism with Binswanger＇s disease

目的探索血压波动及血管紧张素原（AGT）M235T基因多态性与皮层下动脉硬化性脑病（BD）的关系。方法BD患者122例（BD组），原发性高血压病（EH）患者108例（EH组），分别对所有人组者进行24h动态血压监测，并采用聚合酶链式反应一限制性片段长度多态性（PCR—PFLP）技术检测其AGTM235T基因多态性。结果MM＋MT基因型及M等位基因的分布频率在BD组（51．6o．4，29．9％）明显高于EH组（27．8％，16．2％）（x2=13．543，11．995，P〈0．01）；BD组患者夜间收缩压波动（11．8±2．8）mmHg、舒张压波动（9．1±2．5）mmHg及24h舒张压波动（11．6±6．0）mmHg水平高于EH组患者的对应水平（10．9±2．4，8．2±3．2，10．1±4．6）mmHg（t=2．59、2．64、2．09，均P〈0．05）。反杓型血压昼夜节律在BD组分布频率（32．8%）明显高于EH（16．7％）组（x2=7．894，P〈0．01）。同时BD患者中，MM＋MT基因型者中反杓型血压昼夜节律的分布频率（44．4％）高于TT基因型者（20．3％）（x2=8．760，P％0．01）。结论BD患者夜间舒张压、收缩压及24h舒张压波动明显且其AGTM235T基因多态性更多地表现为MM＋MT型，而MM＋MT基因型的BD患者反杓型血压昼夜节律的分布频率更高。

Objective To detect the relationship of blood pressure variability （BPV） and angiotensinogen（AGT） T235M polymorphism with Binswangerrs disease （BD）. Methods Totally 122 cases with BD and 108 cases with essential hypertension had been enrolled. Ambulatory blood pressure monitoring was used to get the data of BPV and mean blood pressure （MBP）. PCR-RFLP was applied to detect genotype of AGT T235M. Results Distribution of MM＋MT genotype and frequency of M allelic were higher in BD group （51.6% ,29.9~~） than in hypertension group（27.8%, 16.2%） （x2 =13. 543,11. 995,P〈0.01）. The variability of night time blood pressure （11.8±2.8, 9. 1 ± 2.5） and 24 hours diastolic blood pressure（11.6 ± 6.0） in BD group were increased compared with those in hypertension groups（10.9±2.4, 8.2±3.2, 10.1±4.6）（t=2.59,2.64,2.09,all P〈0.05）. Prevalence of anti-dipper was higher in BD group （32.8%） than in EH group （16.7%）（x2 =7. 894,P d0.01）. Among BD patients, anti-dipper who carried MM or MT genotypes （44.4 % ） was more than that who carried TT genotype （20.3%） （±2 = 8. 760, P〈 0.01）. Conclusions Fluctuations of nighttime blood pressure and diastolic pressure are higher in patients with BD, and the relative frequency of MM or MT genotype is higher. Moreover, among patients with BD who carried MM or MT genotypes are apt to have anti-dipper. MM or MT genotype is related to BD by means of affecting blood pressure circadian rhythms probably.