基于管壁磁共振成像初步探讨颈动脉粥样硬化斑块与血管紧张素转换酶基因多态性的关系

Relationship between Angiotensin Converting Enzyme Gene Polymorphism and Carotid Atherosclerotic Plaque: A Study Based on Vessel Wall Magnetic Resonance Imaging

目的应用管壁磁共振成像技术,初步探讨原发性高血压患者颈动脉粥样硬化斑块稳定状态、管壁形态及临床症状与血管紧张素转换酶(ACE)基因多态性的关系。方法前瞻性收集2012年3月至2014年9月行颈动脉管壁磁共振成像的原发性高血压患者,以单侧颈内动脉斑块为独立样本,最终纳入最大厚度≥1.5 mm颈内动脉斑块75例。据ACE插入(I)或缺失(D)基因多态性,分为ACEⅡ基因型37例、ACE ID/DD基因型38例。统计分析2组斑块内容物、管壁形态及临床症状差异,以及是否服用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂对各组管壁形态的影响。结果与ACEⅡ基因型高血压患者相比,ACE ID/DD基因型患者较易发生缺血性脑卒中,差异有统计学意义(χ~2=3.921,P=0.048)。2组颈内动脉斑块内容物及管壁形态指标差异均无统计学意义(P均>0.05)。在ACE ID/DD基因型患者中,21例服用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂降压药物患者比17例未服用者的颈动脉重构指数小,差异有统计学意义(1.85±0.60比2.48±0.40;t=3.854,P=0.001)。结论在原发性高血压患者中,ACE ID/DD基因型与颈动脉粥样硬化斑块之间可能存在关联性。

Objective To investigate the relationship between angiotensin converting enzyme(ACE)gene polymorphism and carotid plaque composition,vessel wall morphology,and clinical symptoms based on vessel wall magnetic resonance imaging.Methods Totally 75 hypertensive patients(75 internal carotid artery plaques)with maximum plaque thickness≥1.5 mm,according to the ACE insertion(I)or deletion(D)gene polymorphism,were divided into ACEⅡgenotype group(n=37)and ACE ID/DD genotype group(n=38).The influences of plaque composition,vessel wall morphology,clinical symptoms,and use of ACE inhibitor or angiotensin receptor blocker(ACEI/ARB)on vessel wall morphology were analyzed.Results Compared with ACEⅡgenotype group,the ACE ID/DD genotype group had significantly higher incidence of ischemic stroke(χ2=3.921,P=0.048).The plaque composition and vessel wall morphology showed no significant difference between these two groups.Inside ACE ID/DD genotype group,the carotid remodeling index was significantly lower in users of ACEI/ARB than non-users of ACEI/ARB(1.85±0.60 vs.2.48±0.40;t=3.854,P=0.001).Conclusion In primary hypertension,ACE ID/DD genotype may be associated with carotid atherosclerotic plaque.