载脂蛋白E基因与脑血管淀粉样变对高血压脑出血的影响

Effect of apolipoprotein E gene and cerebrovascular amyloid on hypertensive cerebral hemorrhage

目的探讨载脂蛋白E基因与脑血管淀粉样变对高血压脑出血(HICH)的影响。方法收集2013-06—2014-06我院住院治疗的HICH患者(脑出血组)及体检中心体检的正常成人(对照组)的标本及资料,其中脑出血组300例,对照组150例,采用H-E染色及刚果红染色对脑出血组脑标本进行染色观察;PCR-RFLP检测2组apoE基因型分布及等位基因分布,采用半定量RT-PCR测量β淀粉样蛋白前体(Aβ16-17)的表达,分析检测结果。结果脑出血脑标本在显微镜下可见血管壁中层和外膜有淀粉样物沉积,H-E染色时呈现非结晶嗜伊红物质,而刚果红染色后淀粉样物质呈桔红色改变。ApoE基因型频率脑出血组以ε3/ε3、ε3/ε4最多,ε2/ε2及ε2/ε3最少。脑出血组ApoEε3基因较对照组显著减少,ApoEε4基因显著增加。ApoE对Aβ16-17的表达有显著影响,其中ε2及ε4基因使脑出血Aβ16-17表达增多,ε3基因使脑出血Aβ16-17表达减少。结论 ApoE对高血压脑出血有影响,ε4为高血压脑出血的危险因子,ε3可能为高血压脑出血的保护因子。ε2及ε4基因增加脑出血Aβ16-17的表达,ε3能降低脑出血Aβ16-17的表达。ApoE通过影响淀粉样蛋白的代谢而影响高血压脑出血。

Objective To investigate the effect of apolipoprotein E gene and cerebrovascular amyloid on hypertensive cere‐bral hemorrhage. Methods The specimens and clinical data of HICH patients in our hospital from June 2013 to June 2014 and normal adults for medical examination from medical center were collected ,cerebral hemorrhage group of 300 cases and control group of 150 cases. H‐E staining and Congo red staining were used to observe the brain specimens in cerebral hemorrhage group ,ApoE genotype distribution and allele distribution between the two groups were detected by PCR‐RFL. The expression of β‐amyloid protein precursor （Aβ16‐17） was measured by semi‐quantitative RT‐PCR ,and then test results were analyzed. Results The amyloid deposition in middle and epicardial vessel wall can be observed under the microscope in cerebral hemor‐rhage brain. HE staining showed amorphous eosinophilic substance , but Congo red staining showed amyloid was orange change. Epsilon3/epsilon3 ,epsilon3/epsilon4 of ApoE genotype frequencies were the most ,while epsilon2/epsilon2 and epsi‐lon2/epsilon3 were the least in cerebral hemorrhage group. ApoE epsilon3 gene was significantly reduced ,but ApoE epsilon4 gene increased significantly in cerebral hemorrhage group. ApoE had a significant impact on Aβ16‐17 expression ,epsilon2 and epsilon4 genes increased the expression of Aβ16‐17 in cerebral hemorrhage group ,and epsilon3 gene reduced the expression of Aβ16‐17 in cerebral hemorrhage group. Conclusion ApoE has an effect on the hypertension cerebral hemorrhage ,epsilon4 is the risk factor for hypertensive cerebral hemorrhage ,and epsilon3 may be the protective factor for hypertensive cerebral hemor‐rhage. Epsilon2 and epsilon4 gene can increase the expression Aβ16‐17 in cerebral hemorrhage;epsilon3 gene can reduce the expression of Aβ16‐17. ApoE has an effect on hypertensive cerebral hemorrhage by affecting amyloid metabolism.