维持性血液透析患者载脂蛋白E基因多态性与心血管并发症的关系

摘要

目的 调查载脂蛋白E( ApoE)基因多态性与维持性血液透析(MHD)患者心血管并发症之间的联系.方法 选取189例MHD的终末期肾脏病( ESRD)患者(实验组)和165例健康人(对照组).检测两组的脂联素、血肌酐( Scr)、尿素氮(BUN)和总胆固醇(TC)、白蛋白(ALB)、三酰甘油(TG)、高密度脂蛋白(HDL-C)和低密度脂蛋白(LDL-C)水平,用PCR-RFLP检测ApoE基因多态性,按基因型将其分为ε 2、ε 3和ε 4三组,观察其心血管相关并发症的发生率.结果 与对照组相比,实验组脂联素、Scr、BUN、TC、TG和LDL-C水平升高,ALB和HDL-C水平降低;实验组中ε 3/3基因型和ε3等位基因的分布频率显著下降,而ε4/3和ε4显著增加.三个不同基因组中,ε 4组脂联素、Scr、BUN和TC等指标水平及低血压、高血压、冠心病和慢性心功能不全的发生率最高,但HDL-C水平最低,ε 3组则与之相反. Logis-tic回归分析证实ε 3/ 3基因型和ε 3等位基因是MHD患者心血管并发症的保护性因素,但ε4/3基因型和ε4等位基因是危险因素.结论 ApoE基因多态性在一定程度上影响行MHD的ESRD患者心血管相关并发症的发生与发展,且ε 4/ 3基因型和ε 4等位基因是ESRD行MHD患者心血管疾病的危险性因素.%Objective To investigate the association between apolipoprotein E ( ApoE) gene polymorphism and cardiovascular complications in maintenance hemodialysis ( MHD) patients. Methods 189 end stage renal disease (ESRD) patients with MHD (experimental group) and 165 healthy people (control group) were selected. Serum levels of serum creatinine ( Scr) , blood urea nitrogen ( BUN) , total cholesterol ( TC) , albumin ( ALB) , triglycer- ide ( TG) , HDL-C and LDL-C were measured. ApoE gene polymorphism was detected by PCR-RFLP. The compo-nents were divided into ε 2, ε 3 and ε 4 groups by genotype. The biochemical indexes, the incidence of cardiovas-cular complications and the frequency of distribution were compared between the two groups. Results Compared with the control group, the levels of adiponectin, Scr, BUN, TC, TG and LDL-C were increased and the levels of albumin and HDL-C were decreased in the experimental group. The frequency of ε 3/3 genotype and ε 3 allele were decreased significantly, while ε 4/3 and ε 4 were increased remarkable in the experimental group as compared with those in the control group. The levels of adiponectin, Scr, BUN and TC in the ε 4 group were elevated,as well as incidences of hypotension, hypertension, coronary heart disease and chronic heart failure, but the level of of HDL-C were reduced compared with other groups, The logistic regression analysis confirmed that the ε 3/3 geno-type and the ε 3 allele were protective factors, but the ε 4/3 genotype and the ε 4 allele were risk factors for cardi-ovascular complications in ESRD with MHD patients. Conclusion This study demonstrates that ApoE gene poly-morphism affects the occurrence and development of cardiovascular complications in MHD patients of ESRD to a certain extent,and ε 4/3 genotype, ε 4 allele are risk factors for cardiovascular disease of ESRD patients on MHD.