| 伏开全,李群星,尹德录,王怡练,邵泽波,宋 洁.载脂蛋白E基因多态性检测对ACS患者降脂疗效的影响[J].,2021,(6):1191-1195 |
| 载脂蛋白E基因多态性检测对ACS患者降脂疗效的影响 |
| Effects of Apolipoprotein E Gene Polymorphism Detection on Lipid-lowering Efficacy in Patients with ACS |
| 投稿时间：2020-07-16 修订日期：2020-08-10 |
| DOI：10.13241/j.cnki.pmb.2021.06.043 |
| 中文关键词: 急性冠脉综合征 载脂蛋白E基因 瑞舒伐他汀 依折麦布 降脂疗效 心血管不良事件 |
| 英文关键词: Acute coronary syndrome Apolipoprotein E gene Rosuvastatin Ezetimibe Lipid-lowering efficacy Adverse cardiovascular events |
| 基金项目:江苏省六个一工程拔尖人才科研项目（LGY2017065） |
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| 中文摘要: |
| 摘要 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组予以瑞舒伐他汀口服（10 mg/d），B组予以瑞舒伐他汀强化治疗（20 mg/d），C组予以瑞舒伐他汀（10 mg/d）+依折麦布（10 mg/d）口服，连续治疗1个月，评价3组各基因表型血脂[总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL-C）]改善情况、LDL-C达标率，记录药物副反应，所有患者随访1个月，统计心血管不良事件（MACE）发生情况。结果：3组ApoE基因E2、E3、E4表型构成比无显著差异（P>0.05）。治疗后，各组不同ApoE基因表型TC、TG、LDL-C水平均较治疗前下降，且变化率比较差异有统计学意义（P<0.05），表现为E2型>E3型>E4型；其中，3组E2表型TC、TG、LDL-C水平变化率无显著差异（P>0.05）；B组、C组E3表型TC、TG、LDL-C水平变化率均显著高于A组（P<0.05），但B组、C组各指标变化率比较差异无统计学意义（P>0.05）；3组E4表型TC、TG、LDL-C水平变化率比较差异有统计学意义（P<0.05），且表现为C组>B组>A组。治疗后，A组LDL-C达标率为61.67%，显著低于B组的85.00%、C组的90.00%（P<0.05）；其中，3组E2表型LDL-C达标率比较无显著差异（P>0.05），A组E3表型LDL-C达标率显著低于B组、C组（P<0.05），A组、B组E4表型LDL-C达标率低于C组（P<0.05）。治疗期间，仅B组出现1例ALT超出正常上限3倍，停药后可恢复正常。3组MACE发生率比较差异有统计学意义（P<0.05），表现为A组发生率18.33%明显高于B组5.00%、C组3.33%（P<0.05），但3组E2、E4型MACE发生率均无明显差异（P>0.05），而A组E3型MACE发生率高于B组、C组（P<0.05）。结论：ACS患者降脂疗效与ApoE基因表型有关，对E2表型单用瑞舒伐他汀即可取得良好降脂效果，对E3表型强化瑞舒伐他汀或联合依折麦布治疗较单用瑞舒伐他汀均能提高降脂效果，而对E4表型联合依折麦布降脂效果优于单用瑞舒伐他汀或强化治疗。 |
| 英文摘要: |
| 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. |
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