载脂蛋白E基因多态性检测对ACS患者降脂疗效的影响

目的:探究载脂蛋白E(ApoE)基因多态性检测在急性冠脉综合征(ACS)患者降脂治疗的中应用价值.方法:选取2019年2月～2020年6月180例ACS患者,采用随机数字表法分为A、B、C共3组各60例,各组患者均接受ApoE基因多态性检测,并根据Sanger法测序判断ApoE基因表型(E2、E3、E4表型),A组予以...

Effects of Apolipoprotein E Gene Polymorphism Detection on Lipid-lowering Efficacy in Patients with ACS

ABSTRACT Objective: To explore the application value of apolipoprotein E (ApoE) gene polymorphism detection in lipid-lowering therapy of patients with acute coronary syndrome (ACS). Methods: 180 patients with ACS from February 2019 to June 2020 were selected, and they were divided into groups A, B and C by using random number table method, with 60 cases in each group. ApoE gene polymorphism was tested among all patients. According to the ApoE gene phenotypes (E2, E3, E4 phenotypes) determined by Sanger sequencing, group A was given oral administration of rosuvastatin (10 mg/d), and group B was given oral administration of rosuvastatin (20 mg/d), and group C was given oral administration of rosuvastatin (10 mg/d) + ezetimibe (10 mg/d). After 1 month of continuous treatment, the blood lipids total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C)] and LDL-C compliance rate were evaluated among the three groups of phenotypes, and the medication side effects were recorded. All patients were followed up for 1 month, and the occurrence of major adverse cardiovascular events (MACE) were counted. Results: There were no statistically significant differences in the composition ratios of E2, E3, and E4 phenotypes of ApoE gene among the three groups (P>0.05). After treatment, the levels of TC, TG and LDL-C of different ApoE gene phenotypes in each group were decreased compared with those before treatment, and there were statistically significant differences in the change rates (P<0.05), manifested as E2 phenotype>E3 phenotype>E4 phenotype (P<0.05). There were no statistically significant differences in the change rates of TC, TG and LDL-C levels of E2 phenotype among the three groups (P>0.05). The change rates of TC, TG and LDL-C levels of E3 phenotype patients in groups B and C were significantly higher than those in group A(P<0.05), but there was no significant difference in the change rate of each index between group B and group C(P>0.05). There were statistically significant differences in the change rates of TC, TG and LDL-C levels of E4 phenotype patients among the three groups (P<0.05), showing group C>group B>group A (P<0.05). After treatment, the LDL-C compliance rate in group A was significantly lower than that in group B and group C (61.67% vs 85.00% vs 90.00%) (P<0.05). There was no statistically significant difference in the LDL-C compliance rate of E2 phenotype patients among the three groups (P>0.05). The LDL-C compliance rate of E3 phenotype patients in group A was significantly lower than that in groups B and C (P<0.05), and the LDL-C compliance rate of E4 phenotype patients in group A and group B was lower than that in group C (P<0.05). During treatment, only one case in group B was with ALT exceeding 3 times of the upper limit of normal value, and the patient could return to normal after drug withdrawal. There was a statistically significant difference in the incidence rate of MACE among the three groups (P<0.05). The incidence rate in group A was significantly higher than that in group B and group C (18.33% vs 5.00% vs 3.33%) (P<0.05), but there was no significant difference in the incidence rate of MACE between E2 phenotype patients and E4 phenotype patients in the three groups (P>0.05), and the incidence rate of MACE of E3 phenotype patients in group A was higher than that in groups B and C (P<0.05). Conclusion: The lipid-lowering efficacy in patients with ACS is related to the ApoE gene phenotypes. Rosuvastatin alone can achieve a good lipid-lowering effect for the E2 phenotype, and rosuvastatin intensive treatment or combination of ezetimibe for E3 phenotype can better improve the lipid-lowering effect than rosuvastatin alone, and combination of ezetimibe for E4 phenotype has better lipid-lowering effect than rosuvastatin alone or intensive treatment.