载脂蛋白E基因多态性和动脉瘤性自发蛛网膜下腔出血预后相关性

The influence of APOE gene polymorphism on the prognosis of spontaneous aneurysmal subarachnoid hemorrhage (SAH)

目的 探讨载脂蛋白E(ApoE)基因多态性和动脉瘤性自发蛛网膜下腔出血 (SAH)预后的关系。 方法 对 10 4例动脉瘤性SAH患者采用哥拉斯格预后评分 (GOS) ,对伤后 3个月的恢复情况进行评估。测定患者的血脂ApoE基因多态性 ,通过限制性片段长度多态性而确定 (RFLP)。结果 病例组的基因型和等位基因频率与正常对照组无显著性差异 (P >0 .0 5 )。在 18例ApoE∈ 4等位基因携带者中有 5例 (2 7.8% )预后不良 ,明显高于非∈4等位基因携带者 (8.1% ,P =0 .0 32 ) ;单因素和多因素Logistic回归均提示仅∈ 4是预后不良的危险因素 (单因素OR =4 .34,P =0 .0 2 6 ;多因素OR =6 .95 ,P =0 .0 30 )。结论 APOE∈ 4等位基因是动脉瘤性SAH患者预后不良的危险因素。

Objective To explore the relationship between APOE gene polymorphism and the prognosis of spontaneous aneurysmal subarachnoid hemorrhage (SAH).Methods A total of 104 patients with aneurysmal SAH were studied.The results were evaluated with glasgow outcome scale (GOS) 3 months after SAH.The levels of patients serum lipid were measured.The APOE polymorphism was determincd by PCR followed by RFLP.Results The distributions of APOE genotypes and alleles in patients matched that in control subjects.That 5 of 18 patients with APOE ∈4 (28%) had an infavorable results is significantly different from those without APOE ∈4 (7/86,8%) (χ 2, P =0.032;univariate logistic regression,or=4.34,95% CI 1.20～15.75, P =0.026).However neither the presence of ∈2 nor ∈3 was significantly different from these absent of it.The relative hagard of APOE ∈4 for unfavorable results still remained after adjustment for clinical assessment (OR=6.95;95% CI 1.21～39.75, P =0.030).Serum total cholesterol,low density lipoprotein cholesterol and apolipoprotein B were higher in patients with unfavorable results than in those with favorable ones.Conclusions Our findings showed that the patients with APOE ∈4 allele predispose unfavorble result after aneurysmal SAH,although there may be no association of APOE with incidence of aneurysmal SAH.