载脂蛋白A多态性和他汀类药物治疗颈动脉粥样硬化疗效的相关性

Correlation between apolipoprotein A polymorphisms and efficacy of statin therapy for carotid atherosclerosis

目的观察载脂蛋白A[apolipoprotein,Apo(a)]基因rs3798220多态性对他汀类药物治疗颈动脉粥样硬化患者疗效的影响。方法对2012年4月至2013年4月在广东省佛山市顺德第一人民医院心内科及高级诊疗区住院部已经确诊的103例患者进行基因分型,并对患者采用阿托伐他汀20 mg/d进行治疗,临床随访2年。检测治疗前、后患者的血浆脂蛋白。a[lipoprotein a,LP(a)]浓度及血清三酰甘油(triacylglycerol,TG),总胆固醇(total cholesterol,TC),低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C),高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)浓度。结果他汀类药物治疗能够显著降低颈动脉内膜中层厚度(IMT)、降低血清TC、TG、LDL-C浓度、升高血清HDL-C浓度,但是对血浆Lp(a)浓度没有显著影响。通过对他汀类药物治疗颈动脉粥样硬化患者的疗效进行分析发现,采用他汀类药物治疗时Apo(a)基因rs3798220的分型对颈动脉内膜中层厚度、TG、Lp(a)以及HDL-C的改善没有影响,对LDL-C有一定的影响,而对TC有显著影响。结论他汀类药物治疗颈动脉粥样硬化患者能够取得良好的效果。Apo(a)基因rs3798220多态性对他汀类药物治疗疗效有一定的影响,其能够成为他汀类药物治疗颈动脉粥样硬化患者效果的辅助判断,为颈动脉粥样硬化以及冠状动脉粥样硬化性心脏病(冠心病)患者的个体化医疗提供依据。

Objectives To study the correlation between apolipoprotein A [ Apo （a）] polymorphisms and curative effect of statin therapy for carotid atherosclerosis （CAS）. Methods Totally 103 patients with CAS were recruited and genotyped from April 2012 to April 2013 in The First People＇s Hospital of Shunde in Foshan. All of these patients were administered 20 mg atorvastatin one time daily and followed up for two years. Plasma concentration of lipoprotein a [ Lp （a） ], serum concentrations of total cholesterol （TC）, triglyceride （TG）, high-density lipoprotein cholesterol （HDL- C） and low-density lipoprotein cholesterol （LDL-C） were detected by automatic biochemical analyzer before and after treatment. Results Statin treatment significantly reduced carotid intima-media thickness （IMT）, serum concentrations of TC,TG,LDL-C and increased serum concentration of HDL-C, but showed no significant effect on plasma concentration of Lp （a）. According to the curative effect of statin therapy in patients with CAS, Apo （a） polymorphisms had no effect on the improvement of IMT, TG, HDL-C and Lp （a）, but had a certain influence on LDL-C and a significant effect on the improvement of TC. Conclusions Statin therapy in patients with CAS can obtain a good effect. Apo （a） polymorphisms have a certain influence on the curative effect and they can help in judgement for the curative effect of statin treatment, which provides evidence for individualized medication in CAS patients.