溶质载体有机阴离子转运蛋白家族成员1B1和载脂蛋白E基因多态性与动脉粥样硬化他汀类药物治疗效果的关系研究

Study on the relationship between solute carrier organic anion transporter family member 1B1 and apolipoprotein E gene polymorphisms and the effect of statins on atherosclerosis

目的探讨溶质载体有机阴离子转运蛋白家族成员1B1(SLCO1B1)和载脂蛋白E(ApoE)基因多态性与动脉粥样硬化(AS)他汀类药物治疗效果的关系。方法回顾性分析2020年6月至2021年6月于四川绵阳四0四医院心内科行植入冠状动脉支架并明确诊断为冠状AS心脏病的577例患者的临床资料,最终纳入患者550例。所有患者均行颈动脉彩超检查及冠状动脉支架植入,支架植入术后常规检测SL-CO1B1、ApoE基因。定期复查颈动脉彩超和冠状动脉造影,冠状动脉支架植入后经冠状动脉造影或颈动脉彩超判断病变稳定或改善459例,纳入治疗成功组;经冠状动脉造影或颈动脉彩超判断病变进展和有新发不良心脑血管事件91例,纳入治疗失败组。比较两组临床资料及SL-CO1B1基因分类、ApoE基因类型分布情况。结果治疗失败组男性占比、术后1年低密度脂蛋白(LDL)水平均高于治疗成功组,差异有统计学意义(P<0.05);两组年龄、LDL水平、高密度脂蛋白(HDL)水平、体重指数、支架数及高血压、糖尿病、吸烟、家族史情况比较差异无统计学意义。治疗失败组SLCO1B1基因Ⅲ类占比高于治疗成功组,差异有统计学意义(P<0.05);两组SLCO1B1基因Ⅰ类、Ⅱ类占比比较差异无统计学意义。治疗失败组ApoE基因分型为ApoE4型者占比高于治疗成功组,差异有统计学意义(P<0.05);两组ApoE基因分型为ApoE2、3型者占比比较差异无统计学意义。结论他汀SLCO1B1、ApoE基因多态性与进展性AS他汀类药物的治疗效果有关,在进展性动脉粥样硬化表现的患者中早期检测SLCO1B1、ApoE基因多态性并及时调整治疗方案有助于改善患者预后。

Objective To investigate the relationship between solute carrier organic anion transporter family member 1B1(SLCO1B1)and apoli-poprotein E(ApoE)gene polymorphism and the effect of statins on atherosclerosis.Methods The clinical data of 577 patients who received coro-nary artery stent implantation and were diagnosed with coronary AS heart disease in the department of Cardiology of 404 Hospital in Mianyang,Sich-uan Province from June 2020 to June 2021 were retrospectively analyzed,and 550 patients were finally included.Carotid artery color ultrasound and coronary stent implantation were performed in all patients,and SLCO1B1 and ApoE genes were routinely detected after stent implantation.Carotid color ultrasound and coronary angiography were regularly reviewed,and 459 cases were found to be stable or improved by coronary angiography or carotid color ultrasound after coronary stent implantation,and were included in the successful treatment group;91 patients with disease progression and new adverse cardiovascular and cerebrovascular events judged by coronary angiography or carotid artery color Doppler ultrasound were included in the failure treatment group.The clinical date,the distribution of SLCO1B1 gene classification and ApoE gene types was compared between the two groups.Results The proportion of males and the level of low-density lipoprotein(LDL)at 1 year after operation in the failed treatment group was higher than those in the successful treatment group,and the differences were statistically significant(P<0.05);there was no significant differ-ence in age,LDL level,high-density lipoprotein(HDL)level,body mass index,number of stents,and hypertension,diabetes,smoking and family his-tory between the two groups.The proportion of SLCO1B1 gene classⅢin the failure treatment group was higher than that in the successful treat-ment group,and the difference was statistically significant(P<0.05);there was no statistically significant difference in the proportion of classⅠand classⅡSLCO1B1 genes between the two groups.The proportion of ApoE genotype 4 in the failure treatment group was higher than that in the suc-cessful treatment group,and the difference was statistically significant(P<0.05);there was no statistically significant difference in the proportion of individuals with ApoE genotype 2 and 3 between the two groups.Conclusion Statin SLCO1B1 and ApoE gene polymorphisms are related to the therapeutic effect of statins for progressive atherosclerosis,suggesting that early detection of SLCO1B1 and ApoE gene polymorphisms and timely adjustment of treatment plan in patients with progressive atherosclerosis may help to improve the prognosis of patients.