Hcy水平无明显差异的H型高血压患者MTHFR C677T基因多态性与脑卒中的相关性

The Correlation Between MTHFR C677T Gene Polymorphism and Stroke in Patients with H-type Hypertension of Same Hcy Level

目的:探讨同型半胱氨酸(Hcy)水平无明显差异的H型高血压患者亚甲基四氢叶酸还原酶(MTHFR)C677T基因多态性与脑卒中发生的关系。方法:选取500例确诊为H型高血压发生急性脑卒中的患者为病例组(按血Hcy水平进行分层,以性别和年龄为匹配原则),选择500例同期从未发生脑卒中的H型高血压患者作为对照组;比较2组患者一般基线资料(糖尿病、房颤、饮酒及吸烟人数)、体格检查指标[收缩压、舒张压、心率及体质量指数(BMI)]及实验室指标[血总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及三酰甘油(TG)],比较2组患者MTHFR C677T基因型及等位基因频率;以有无卒中为因变量,将P<0.1的因素作为自变量,纳入Logistic回归分析,分析H型高血压患者发生脑卒中的独立危险因素。结果:病例组的吸烟人数、血LDL-C浓度及TT基因型明显高于对照组,差异均有统计学意义(P<0.05);Logistics回归分析显示,吸烟(OR=2.342,95%CI为1.156~4.202)、高LDL-C血症(OR=1.050,95%CI为1.026~1.075)及TT基因型(OR=0.431,95%CI为0.234~0.793)是H型高血压患者发生脑卒中的独立危险因素(P<0.05)。结论:MTHFR C677T基因多态性影响H型高血压的脑卒中发生率,TT基因型是H型高血压患者发生脑卒中的危险因素。

Objective: To investigate the relationship between methylenetetrahydrofolate reductase( MTHFR) C677 T gene polymorphism and stroke of H-type hypertension with no significant difference in homocysteine( Hcy) level. Methods: A total of 500 patients diagnosed as stroke with H-type hypertension in three hospitals were selected as case group( stratified with Hcy level and matching randomly according to age and gender),500 cases who had never had stroke were selected as control group. Two groups patients were compared with baseline data( diabetes,atrial fibrillation,drinking and smoking),physical examination index [systolic pressure,diastolic blood pressure,heart rate and body mass index( BMI) ]and laboratory index [blood total cholesterol( TC),low-density lipoprotein cholesterol( LDL-C),high density lipoprotein cholesterol( HDL-C),three acyl glycerin( TG) ]while two groups of patients were compared with MTHFR genotype and allele frequency;the dependent variable and independent variables were set and included in Logistic regression analysis. The independent risk factors for stroke in patients with h-type hypertension were analyzed between gene ploymorphisms in C677 T of MTHFR and stroke. Results: The number of smokers,blood LDL-C concentration and TT genotype in the case group were significantly higher than those in the control group,the differences were statistically significant( P < 0. 05). Logistic regression analysis showed that smoking( OR = 2. 342,95% CI: 1. 156 ~ 4. 202),high LDL-C( OR = 1. 050,95% CI: 1. 026 ~1. 075),TT genotype( OR = 0. 431,95% CI: 0. 234 ~ 0. 793) were independent risk factors for stroke in patients with h-type hypertension( P < 0. 05). Conclusion: MTHFR C677 T gene polymorphism affects the incidence of stroke in H-type hypertension,the TT genotype may be a risk factor for stroke in patients with H-type hypertension while CC genotype may be a protective factor for stroke.