ApoE基因多态性与脑梗死患者他汀类药物调脂疗效的关系分析

Relationship between ApoE gene polymorphism and lipid-lowering efficacy of statins in patients with cerebral infarction

目的探讨载脂蛋白(Apo)E基因多态性与脑梗死患者他汀类药物调脂疗效的关系。方法选取2019-2022年该院连续服用他汀类降脂药物至少1个月的脑梗死患者364例,根据其服药时间分为T1组(连续服药1个月,126例)、T2组(连续服药2个月,62例)、T3组(连续服药3个月及以上,176例),使用PCR-荧光探针法测定患者的ApoE基因型,回顾性分析各组患者服药前后血清甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)和总胆固醇(TC)水平与ApoE基因表型的关系。结果T1组患者按生化表型分为E2型14例(11.11%)、E3型87例(69.05%)、E4型25例(19.84%);T2组患者按生化表型分为E2型4例(6.45%)、E3型43例(69.35%)、E4型15例(24.19%);T3组患者按生化表型分为E2型23例(13.07%)、E3型125例(71.02%)、E4型28例(15.91%)。3组患者的基线资料比较,差异无统计学意义(P>0.05)。服药前各表型血脂水平无明显改变,服药后TC、LDL-C、TG水平均降低,HDL-C水平均升高(P<0.05)。服药后T2组患者中E3、E4型人群LDL-C水平比E2型降低更为明显(P<0.05)。服药后T3组患者中E2型比E3、E4型LDL-C水平降低更为明显(P<0.05),E2型比E4型TC水平降低更为明显(P<0.05)。结论ApoE基因多态性与他汀类药物的调脂疗效具有密切联系,在临床使用他汀类药物治疗时应采取个体化的服药方案。

Objective To investigate the relationship between apolipoprotein(Apo)E gene polymorphism and lipid-lowering efficacy of statins in patients with cerebral infarction.Methods From 2019 to 2022,totally 364 patients with cerebral infarction who have taken statins for at least one month in the hospital were divided into three groups according to the time of taking statins:T1 group(one month of continuous medication,126 cases),T2 group(two months of continuous medication,62 cases)and T3 group(three months or more of continuous medication,176 cases).ApoE genotype was determined by PCR-fluoresscent probe method.The relationships between serum triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)and total cholesterol(TC)and ApoE genotype were analyzed retrospectively.Results In T1 group,there were 14 cases(11.11%)of E2,87 cases(69.05%)of E3 and 25 cases(19.84%)of E4 according to biochemical phenotype.In T2 group,there were 4 cases(6.45%)of E2,43 cases(69.35%)of E3 and 15 cases(24.19%)of E4 according to biochemical phenotype.In T3 group,there were 23 cases(13.07%)of E2,125 cases(71.02%)of E3 and 28 cases(15.91%)of E4 according to biochemical phenotype.There was no significant difference in baseline data among the three groups(P>0.05).There was no significant difference in blood lipid levels among different phenotypes before taking medicine.After taking medicine,the levels of TC,LDL-C and TG decreased,and the level of HDL-C increased(P<0.05).The level of LDL-C in patients with E3 and E4 phenotypes was significantly lower than that in patients with E2 phenotype in T2 group(P<0.05).In T3 group,the level of LDL-C in E2 group was significantly lower than that in E3 and E4 group(P<0.05),and the level of TC in E2 group was significantly lower than that in E4 group(P<0.05).Conclusion ApoE gene polymorphism is closely related to the lipid-lowering effect of statins,and individualized medication regimen should be adopted when statins are used in clinical practice.