APOE 基因多态性与经皮冠状动脉介入治疗后支架内再狭窄的相关性研究

Association of APOE gene polymorphism with in-stent restenosis in patients with coronary heart disease after PCI

目的探讨载脂蛋白E(APOE)基因多态性与冠心病(CHD)患者行经皮冠状动脉介入治疗(PCI)后支架内再狭窄(ISR)的相关性。方法选择2016年1月—2018年10月在徐州医科大学附属医院接受冠状动脉药物洗脱支架(DES)植入术并在术后12~36个月内复查冠状动脉造影的冠心病患者172例。根据冠状动脉造影结果分为再狭窄(ISR)组和非再狭窄(non-ISR)组。单因素分析比较ISR组与non-ISR组患者的一般资料、造影特征、服药情况、血液学指标、APOE基因型。以单因素分析中有统计学差异(P<0.05)的指标为自变量,以ISR为因变量,进行二元Logistic回归分析,研究ISR的独立危险因素。结果单因素分析显示ISR组低密度脂蛋白胆固醇(LDL-C)水平、糖化血红蛋白(HbA1c)水平、E3/4基因型频率、支架串联长度、支架数均高于non-ISR组(P<0.05),而最小支架直径小于non-ISR组(P<0.05)。携带E3/4基因型患者血清LDL-C水平明显升高。Logistic回归分析显示E3/4基因型、HbA1c、LDL-C水平为ISR的独立危险因素。结论APOE基因多态性与ISR有关,E3/4基因型是ISR的独立危险因素。进一步的遗传学研究可以识别危险基因型,有助于早期预测和识别ISR高危患者。

Objective To investigate the association between apolipoprotein E(APOE)gene polymorphism and in-stent restenosis(ISR)in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods A total of 172 patients with CHD who underwent drug-eluting coronary stent implantation in the Affiliated Hospital of Xuzhou Medical University from January 2016 to October 2018 and were reexamined by coronary angiography within 36 months were enrolled in this study.According to the results of coronary angiography,the patients were divided into ISR group and non-ISR group.Univariate analysis was used to compare the general data,angiographic features,medication,hematological parameters and APOE genotypes between the ISR group and the non-ISR group.The independent risk factors of ISR were studied by binary logistic regression analysis with the indexes with statistical difference(P<0.05)as independent variables and ISR as dependent variables.Results Univariate analysis showed that the levels of LDL-C and HbA1c,the frequency of genotype E3/4,the stent length and the number of stents in the ISR group were higher than those in the non-ISR group,while the stent diameter was smaller than that in the non-ISR group(P<0.05).The level of serum low density lipoprotein cholesterol(LDL-C)in patients with E3/4 genotype was significantly higher than that in the controls.Logistic regression analysis showed that E3/4 genotype,hemoglobin A1c(HbA1c)and LDL-C levels were independent risk factors for ISR.Conclusions Polymorphism of APOE gene is associated with ISR,and E3/4 genotype is an independent risk factor for ISR.Further genetic studies can identify risk genotypes,which is helpful for early prediction and identification of high-risk patients with ISR.