ApoE基因多态性与高脂血症患者降脂疗效的相关性

Association between apolipoprotein E gene polymorphism and lipid-lowering efficacy in patients with hyperlipidemia

目的探讨载脂蛋白E(ApoE)基因多态性与高脂血症患者降脂疗效的相关性,指导临床合理用药。方法选取高脂血症患者100例,每晚睡前口服阿托伐他汀20mg降脂治疗,治疗4周,治疗前后检测血清血脂指标。计算治疗前后LDL-C下降率,以LDL-C在治疗前后下降率40%为界,分为他汀治疗高疗效组56例和他汀治疗低疗效组44例。采用实时荧光定量PCR法检测ApoE基因。结果100例高脂血症患者共检出E2/3、E2/4、E3/3、E3/4 4种基因型和ε2、ε3、ε4 3种等位基因,E2/2、E4/4 2种基因型未检出。E2型基因组、E4型基因组与E3型基因组TC、HDL-C、LDL-C水平比较差异均有统计学意义(均P<0.05),其中E4型基因组TC、LDL-C水平最高。他汀治疗低疗效组E3/3基因型检出率、ε3等位基因检出率均低于他汀治疗高疗效组,E3/4基因型检出率、ε4等位基因检出率均高于他汀治疗高疗效组,两组比较差异均有统计学意义(均P<0.05)。结论 ApoE基因多态性与高脂血症患者降脂疗效相关性较大,ε4等位基因影响阿托伐他汀降脂疗效。

Objective To investigate the relationship between apolipoprotein E( ApoE) gene polymorphism and lipid-lowering efficacy in patients with hyperlipidemia. Methods One hundred patients with hyperlipidemia were enrolled from July 2016 to December 2017.Patients were treated with atorvastatin 20 mg/d for 4 weeks, and serum lipid indexed were determined before and after treatment. According to the decrease of LDL-C level by 40%, patients were divided into high efficacy group and low efficacy group. ApoE DNA sequence was detected by real-time fluorescence PCR. Results Four genotypes E2/3, E2/4, E3/3, E3/4 and three alleles ε2,ε3,ε4 were detected;no E2/2 and E4/4 were detected. There were significant differences in TC,HDL-C and LDL-C levels between E3 genotype(E3/3) and E2(E2/3, E2/4), E4(E3/4) genotypes(all P<0.05);the levels of TC and LDL-C in E4 group were higher. The frequency distribution of genotype E3/3 and ε3 allele in the low efficacy group were lower than that in high efficacy group(both P<0.05);the frequency distribution of genotype E3/4 and ε4 allele in the low efficacy group were higher than that in high efficacy group(both P<0.05). Conclusion ApoE gene polymorphism is significantly correlated with lipid-lowering efficacy, and the ε4 allele affects the efficacy of atorvastatin in reducing lipids.