HCMV感染及载脂蛋白E基因多态性与原发性高血压和心血管病变的关系

Relationship between HCMV infection, apolipoprotein E gene polymorphism and essential hypertension and cardiovascular diseases

目的分析人巨细胞病毒(HCMV)感染及载脂蛋白E(apoE)基因多态性与原发性高血压(EH)发病和心血管病变的关系。方法选择2016年10月-2019年10月宁夏医科大学附属银川市中医医院收治的100例EH患者作为EH组,将同期59名健康体检者作为对照组,比较两组临床资料与实验室指标,并分析不同分级EH患者HCMV DNA阳性率、HCMV免疫球蛋白G(IgG)阳性率、HCMV IgM阳性率和apoE基因多态性,采用Logistic回归分析EH患者颈动脉内膜增厚的影响因素。结果两组平均动脉压(MAP)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、胰岛素抵抗指数(HOMA-IR)、血管内膜中层厚度(cIMT)、HCMV DNA阳性率、HCMV IgG阳性率、HCMV IgM阳性率、apoE基因E3/3、E3/4、E4/4基因型以及E3、E4等位基因频率,差异有统计学意义(P<0.05);血压水平越高,EH患者LDL-C、HOMA-IR、cIMT水平越高(P<0.05),HCMV DNA阳性率、HCMV IgG阳性率、HCMV IgM阳性率、apoE基因E4/4基因型以及E4等位基因频率越高(P<0.05),apoE基因E3/3基因型频率越低(P<0.05);Spearman相关性分析显示,E3/3基因型与cIMT呈负相关(P<0.05),HCMV IgM、E4/4基因型与HOMA-IR呈正相关(P<0.05);平均动脉压(MAP)、HOMA-IR、HCMV DNA、HCMV IgG、apoE基因E4/4基因型为EH患者颈动脉内膜增厚的影响因素(P<0.05),apoE基因E3/3基因型为保护因素(P<0.05)。结论随着血压水平升高,apoE基因E3/3基因型频率减少、E4/4基因型以及E4等位基因频率增加,且HCMV感染和apoE基因多态性是EH患者心血管病变的影响因素。

OBJECTIVE To analyze the relationship between human cytomegalovirus(HCMV)infection and apolipoprotein E(apoE)gene polymorphism and the onset of essential hypertension(EH)and cardiovascular diseases.METHODS 100 patients with EH admitted to Yinchuan Traditional Chinese Medicine Hospital affiliated to Ningxia Medical University from Oct.2016 to Oct.2019 were selected as EH group,and 59 healthy subjects admitted during the same period were selected as control group.The clinical data and laboratory indicators of the two groups were compared,and the positive rate of HCMV DNA,the positive rate of HCMV immunoglobulin G(IgG),the positive rate of HCMV immunoglobulin M(IgM)and polymorphism of apoE gene in EH patients with different grades were analyzed.The influencing factors of carotid artery intima thickening in EH patients were analyzed by Logistic regression analysis.RESULTS There were significant differences in the mean arterial pressure(MAP),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),homeostasis model assessment of insulin resistance(HOMA-IR),intima media thickness(cIMT),HCMV DNA positive rate,HCMV IgG positive rate,HCMV IgM positive rate,apoE gene E3/3,E3/4 and E4/4 genotypes and E3 allele frequency and E4 allele frequency between the two groups(P<0.05).The higher the blood pressure level was,the higher the levels of LDL-C,HOMA-IR,and cIMT was in EH patients(P<0.05),the greater the HCMV DNA positive rate,HCMV IgG positive rate,HCMV IgM positive rate,E4/4 genotype of apoE gene and E4 allele frequency was detected(P<0.05),and the lower the frequency of apoE gene E3/3 genotype was(P<0.05).Spearman correlation analysis showed that the E3/3 genotype was negatively correlated with cIMT(P<0.05),and HCMV IgM and E4/4 genotype were positively correlated with HOMA-IR(P<0.05).MAP,HOMA-IR,HCMV DNA,HCMV IgG and E4/4 genotype of apoE gene were the influencing factors of carotid artery intima thickening in EH patients(P<0.05),and the E3/3 genotype of apoE gene was a protective factor(P<0.05).CONCLUSION With the increase of blood pressure,the frequency of E3/3 genotype of apoE gene decreased,the frequencies of E4/4 genotype and E4 allele increased,and HCMV infection and apoE gene polymorphism were the influencing factors for cardiovascular diseases in EH patients.