冠心病患者ApoE基因多态性与血脂及颈动脉病变的相关性研究

Correlation between ApoE gene Polymorphism and Blood Lipid and Carotid Artery Disease in Patients with Coro⁃nary Heart Disease

目的:探讨冠心病患者血脂及颈动脉病变与ApoE基因多态性的相关性。方法:选取2019年1月至2020年8月在我院行冠脉造影术证实冠心病且均行颈动脉超声检查诊断为颈动脉粥样硬化斑块形成者,所有患者均规律服用他汀类药物调脂治疗,共计280例,均行实时荧光定量PCR检测ApoE基因多态性,并根据ApoE基因型分为3组,E2表型组:基因型为E2/2+E2/3者;E3表型组:基因型为E3/3+E2/4者;E4表型组:基因型为E3/4+E4/4者。比较3组的一般临床资料、血脂、颈动脉内中膜厚度(IMT)、颈动脉斑块厚度及狭窄有无差异,并分析与ApoE基因多态性的相关性。结果:⑴在280例患者中,检测出6种基因型:E2/2(4例)、E2/3(39例)、E3/3(146例)、E2/4(19例)、E3/4(70例)、E4/4(2例);⑵3组间一般临床资料比较,差异均无统计学意义(P>0.05);⑶总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平在E4组中高于E2、E3组,差异有统计学意义(P<0.05);⑷IMT值、左右侧颈动脉斑块厚度在E4组中高于E2、E3组,差异均有统计学意义(P均<0.05);E4组中颈动脉狭窄发生率高于E2、E3组,差异有统计学意义(P<0.05),且E4表型组基因型存在时对应的颈动脉狭窄相关的ROC曲线提示曲线下面积为0.626(P<0.05)。结论:冠心病患者ApoE基因多态性与血脂、IMT、颈动脉斑块厚度及狭窄有相关性,E4表型组基因型存在时血脂、IMT值、颈动脉斑块厚度水平相对较高且增加颈动脉狭窄风险。

Objective To investigate the relationship between plasma lipids, carotid artery lesions and ApoE polymorphism in patients with coronary heart disease. Methods From January 2019 to August 2020, 280 patients with coronary artery disease confirmed by coronary angiography and diagnosed as carotid atherosclerotic plaque by carotid ultrasound in our hospital were selected. All patients were regularly treated with statins for lipid-lowering treatment. ApoE gene polymorphism was detected by real-time fluorescence quantitative PCR. They were divided into three groups according to ApoE genotype, E2 phenotype group: genotype E2/2 + E2/3;E3 phenotype group: genotype E3/3 + E2/4;E4 phenotype group: genotype E3/4 + E4/4. The general clinical data, blood lipid, carotid intima-media thickness(IMT), carotid plaque thickness and stenosis of the three groups were compared, and the correlation with ApoE gene polymorphism was analyzed. Results ⑴Six genotypes were detected in 280 patients: E2/2(4 cases), E2/3(39 cases), E3/3(146 cases), E2/4(19 cases), E3/4(70 cases), and E4/4(2 cases). ⑵There was no significant difference in clinical data among the 3 groups(P>0.05). ⑶The levels of TC, triglyceride and LDL-C in E4 group were significantly higher than those in E2 and E3 groups(P<0.05). ⑷The IMT and the thickness of left and right carotid plaque in E4 group were significantly higher than those in E2 and E3 groups(P<0.05). The incidence of carotid artery stenosis in E4 group was significantly higher than that in E2 and E3 group(P<0.05). When there were genotypes in E4 phenotype group, the corresponding ROC curve of carotid artery stenosis indicated that the area under the curve was 0.626(P<0.05). Conclusion ApoE gene polymorphism was correlated with blood lipid, IMT, carotid plaque thickness and stenosis in patients with coronary heart disease. When there were genotypes in E4 phenotype group, the levels of blood lipid, IMT value and carotid plaque thickness were relatively high, which increased the risk of carotid stenosis.