急性ST段抬高型心肌梗死患者载脂蛋白E基因多态性与痰瘀证候相关性研究

Correlation Between Apolipoprotein E Gene Polymorphism and Phlegm-stasis Syndrome in Patients with Acute ST-segment Elevation Myocardial Infarction

【目的】探讨急性ST段抬高型心肌梗死(STEMI)患者载脂蛋白E(ApoE)基因多态性与血脂水平及痰瘀证候的相关性。【方法】采用回顾性研究方法,将82例STEMI患者作为观察组,112例健康体检者作为对照组,应用基因分型芯片法检测2组受试者的ApoE基因型,同时检测2组受试者的血脂水平,观察STEMI患者及其不同中医证素(痰证和瘀证)与ApoE基因型多态性的相关性。【结果】(1)观察组与对照组中,均以基因型E3/3频率和表现型E3等位基因频率最高,均大于70%。2组间各基因型和表现型比较,差异均无统计学意义(P>0.05)。(2)观察组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平明显高于对照组,高密度脂蛋白胆固醇(HDL-C)水平明显低于对照组,差异均有统计学意义(P<0.01),提示脂质异常可能是导致STEMI的危险因素之一。(3)E3/4基因型或E4表现型患者以痰证表现为主,而E3/3基因型和E3表现型患者以瘀证表现为主,其中,E3/4基因型患瘀证的概率是E3/3型的0.17倍[OR=0.17,95%CI=(0.03,0.96)],E4表现型患瘀证的概率是E3型的0.15倍[OR=0.15,95%CI=(0.03,0.82)],差异均有统计学意义(P<0.05)。【结论】痰瘀证STEMI的发生发展可能与ApoE基因多态性无关而与其血脂水平相关,其中含有ApoE4表现型的痰证患者更多,故推测当存在ApoE E4等位基因时,良好的脂质控制对患者病情的恢复可能是有益的,而在中医“治未病”方面,化痰可能比化瘀更值得大家关注。

Objective To investigate the correlation of apolipoprotein E(ApoE)gene polymorphism and blood lipid levels with phlegm-stasis syndrome in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A retrospective study was carried out in 82 STEMI patients(serving as the observation group)and in 112 healthy volunteers taking the physical examination(serving as the control group).The ApoE genotype of the subjects in the two groups was detected by genotyping microarray method and the blood lipid levels in the two groups was also detected.The correlation of traditional Chinese medicine(TCM)syndrome elements(phlegm syndrome and blood stasis syndrome)in STEMI patients with the polymorphism of ApoE genotype was investigated.Results(1)In both observation group and control group,the frequency of genotype E3/3 and the frequency of phenotype E3 allele were the highest,all being higher than 70%.There were no significant differences in the genotypes and phenotypes between the two groups(P>0.05).(2)The levels of total cholesterol(TC)and low density lipoprotein cholesterol(LDL-C)were significantly higher,and the level of high density lipoprotein cholesterol(HDL-C)in the observation group was significantly lower than those in the control group,the differences being statistically significant(P<0.01).The results indicated that abnormal lipid levels might be one of the risk factors of STEMI.(3)Patients with E3/4 genotype or E4 phenotype were mainly manifested as phlegm syndrome,while patients with E3/3 genotype and E3 phenotype were mainly manifested as blood stasis syndrome.The probability of suffering from blood stasis syndrome in the patients with E3/4 genotype was 0.17 times as much as that in the patients with E3/3 genotype[OR=0.17,95%CI=(0.03,0.96)],while the probability of suffering from blood stasis syndrome in the patients with E4 phenotype was 0.15 times as much as that in the patients with E3 phenotype[OR=0.15,95%CI=(0.03,0.82)],the differences being statistically significan(t P<0.05).Conclusion The occurrence and development of STEMI with phlegm-stasis syndrome may have no correlation with ApoE gene polymorphism but having correlation with blood lipid levels,and STEMI patients with ApoE4 phenotype usually suffer from phlegm syndrome,which can be deduced that when the ApoE E4 allele is presented,good blood lipid control may be beneficial to the recovery of illness.In terms of“preventive treatment”of TCM,therapy of resolving phlegm may be more worth of addressing importance than the therapy of removing blood stasis.