老年高血压患者血管紧张素转换酶和醛固酮合酶基因多态性与肾素血管紧张素醛固酮的关系

Relationship of ACE and aldosterone coenzyme gene polymorphism with RAAS in elderly hypertensive patients

目的分析老年高血压晨峰患者血管紧张素转换酶(ACE)基因I/D、醛固酮合酶(CYP11B2)基因-344C/T多态性与肾素-血管紧张素-醛固酮系统(RAAS)的相关性。方法选择2016年2月~2017年12月云南省第一人民医院老年病科门诊及住院的老年原发性高血压患者200例,根据清晨血压水平分为晨峰增高组58例和非晨峰增高组142例。分析2组患者ACE基因I/D、CYP11B2基因-344C/T多态性和血浆RAAS参数的差异。结果 2组ACE基因型和等位基因频率比较,差异有统计学意义(χ^2=38.020,P=0.000;χ^2=42.040,P=0.000)。2组CYP11B2基因型和等位基因频率比较,差异无统计学意义(χ^2=0.261,P=0.878;χ^2=0.198,P=0.656)。晨峰增高组DD+TC、DD+TT基因型比例明显高于非晨峰增高组,差异有统计学意义(22.4%vs 3.5%,12.1%vs 2.1%,P<0.01);晨峰增高组II+TT、II+TC基因型比例明显低于非晨峰增高组,差异有统计学意义(13.8%vs 29.6%,P<0.05;5.2%vs 22.5%,P<0.01)。晨峰增高组血浆肾素、血管紧张素Ⅱ和醛固酮水平明显高于非晨峰增高组,差异有统计学意义(P<0.05,P<0.01)。logistic回归分析显示,DD+CC、DD+TC、DD+TT、肾素、血管紧张素Ⅱ为血压晨峰的重要影响因素(OR=8.084,95%CI:1.261~51.832,P=0.027;OR=14.459,95%CI:3.804~54.964,P=0.000;OR=9.753,95%CI:2.255~42.181,P=0.002;OR=1.816,95%CI:1.258~2.620,P=0.001;OR=0.634,95%CI:0.437~0.921,P=0.017)。结论 ACE基因DD型、肾素、血管紧张素Ⅱ是血压晨峰形成的主要影响因素。

Objective To analyze the relationship of angiotensin converting enzyme(ACE)gene I/D and aldosterone coenzyme gene CYP11 B2-344 C/T polymorphism with rennin-angiotensin-aldosterone system(RAAS)in elderly hypertensive patients with morning blood pressure surge(MBPS).Methods Two hundred elderly primary hypertension patients admitted to our hospital from Febrary 2016 to December 2017 were divided into MBPS group(n=58)and non-MBPS group(n=142).The relationship of ACE I/D and CYP11 B2-344 C/T polymorphism with serum RAAS parameters in two groups was analyzed.Results A significant difference was detected in ACE genotype and allele frequency between the two groups(χ^2=38.020,P=0.000;χ^2=42.040,P=0.000)while no significant difference was found in CYP11 B2 genotype and allele frequency between the two groups(χ^2=0.261,P=0.878;χ^2=0.198,P=0.656).The ratio of DD+TC and DD+TT genotypes was significantly higher while that of II+TT and II+TC genotypes was significantly lower in MBPS group than in non-MBPS group(22.4%vs 3.5%,P<0.01;12.1%vs 2.1%,P<0.01;13.8%vs 29.6%,P<0.05;5.2%vs 22.5%,P<0.01).Logistic regression analysis showed that DD+CC,DD+TC,DD+TT genotypes,renin and angiotensinⅡ were the major influencing factors of MBPS(OR=8.084,95%CI:1.261-51.832,P=0.027;OR=14.459,95%CI:3.804-54.964,P=0.000;OR=9.753,95%CI:2.255-42.181,P=0.002;OR=1.816,95%CI:1.258-2.620,P=0.001;OR=0.634,95%CI:0.437-0.921,P=0.017).Conclusion ACE DD genotype,renin and angiotensinⅡare the major influencing factors of MBPS.