ACE、CYP11B2基因多态性与慢性心力衰竭患者醛固酮脱逸的关系

目的:研究CYP11B2-344C/T(醛固酮合成酶)及ACEI/D(血管紧张素转化酶)基因多态性与慢性心力衰竭(CHF)患者实施ACEI治疗后出现醛固酮脱逸表现的关系。方法:回顾分析2008年10月至2012年10月我科收治的252例CHF患者,全部患者应用ACEI治疗3月,醛固酮在基线以上为醛固酮脱逸,依据此标准将患者分为研究组(脱逸组,n=86)与对照组(非脱逸组,n=166),依据PCR(聚合酶链反应)及RFLP(片段长度限制多态性)等方法分别检测两组CYP11B2及ACE基因型,比较两组基因型频率的分布。结果:252例患者中,共86例出现醛固酮脱逸,发生率为34.1%。全部受试患者CYP11B2基因型及ACE基因型频率与Weinberg-Hardy平衡均相符(P均0.05)。研究组ACE I/D三种基因型的组间分布与对照组相较,无统计学差异(P0.05);CYP11B2基因TT型的频率与对照组相较,呈明显统计学差异(P0.05),等位基因C/T频率的组间分布同对照组相较,亦呈明显差异(P0.05)。研究组ACEI/D的基因多态性及CYP11B2-344C/T的多态性中,基因型联合组间分布与对照组相较,无统计学差异(P0.05)。结论:ACE基因多态性与CHF患者ACEI治疗后出现醛固酮脱逸无关,CYP11B2基因T等位基因及TT基因型多态性可能是CHF患者ACEI治疗后发生醛固酮脱逸的高危因素。醛固酮脱逸时,ACE、CYP11B2基因不具有协同效果。

The Relationship between ACE, CYP11 B2 Gene Polymorphism and Escape of Aldosterone in Patients with Chronic Heart Failure

Objective:To study the relationship between CYP11 B2-344-c/T(aldosterone synthase) and ACEI/D(angiotensin converting enzyme gene polymorphism and patients with chronic heart failure (CHF) after the implementation of ACEI treatment aldosterone extruding performance.Methods:252 patients with CHF admitted in our department from October 2008 to October 201 2 were, retrospectively, analyzed. All the patients were treated by ACEI for 3 months. Aldosterone above baseline was considered as aldosterone escape, patients were divided into research group (extruding group, n=86) and control group (non-extruding group, n=166) according to this standard, PCR (polymerase chain reaction) and RFLP (fragment length polymorphism) method were used to detect and compare the CYP11 B2 and ACE genotype distribution.Results:In 252 cases of patients, a total of 86 cases (34.1 %) with aldosterone extruding were observed, All the patients'' CYP1 1B2 gene type and ACE genotype frequency and Weinberg-Hardy balance were consistent (P>0.05). No significant difference was found in the three ACE I/D genotype distribution between research group and control group (P>0.05); the TT frequency of CYP1 1B2 genotype, allele C/T frequency distribution of research group were significantly different from that of the control group(P<0.05). No statistical difference was observed in the team of ACEI/D gene polymorphism and CYP11 B2-344-c/T polymorphism, genotype distribution between the joint groups compared with control group (P>0.05).Conclusion:ACE gene polymorphism had no correlation with the aldosterone escape after ACEI treatment of CHF patients, T allele and genotype TT of CYP11 B2 gene polymorphisms may be risk factors of aldosterone escape after ACEI treatment, ACE, CYP1 1B2 gene hadn''t synergistic effect during the aldosterone escape.