ACE基因I/D多态性与心房颤动相关性的Meta分析

摘要

目的 评价ACE I/D基因多态性对心房颤动(房颤)发病风险的影响.方法 检索PubMed、Web of Science、谷歌学术、中国知网、万方数据库从建库到2016年3月发表的关于ACE I/D基因多态性与房颤发病风险相关性的研究.对纳入的相关文献使用STATA 12.0进行统计学分析,使用固定效应模型或随机效应模型合并的比值比(OR)和95％置信区间(CI)来评价ACE I/D基因多态性和房颤发病风险,同时检测发表偏倚.对各纳入研究按种族,房颤类型,年龄进行亚组分析,并通过敏感性分析寻找可能的异质性来源.结果 本文纳入了20篇有关ACE I/D基因多态性与房颤发病风险的研究,其中病例组3006例,对照组4861例,Meta分析结果显示,显性基因模型合并后的OR值为1.22(95％CI:0.97～1.52),等位基因模型合并后的OR值为1.22(95％CI:1.04～1.43),隐性基因模型合并后的OR值为1.41(95％CI:1.13～1.76),加性模型合并后的OR值为1.48(95％CI:1.11～1.98),共显性基因模型(DDvs.DI:OR=1.36,95％CI:1.09～1.70;DIvs.II:OR=1.12(95％CI:0.89～1.39).在以民族为亚组的亚组分析中,高加索人可以在隐性基因模型中发现ACE I/D基因多态性与房颤有很强的联系(OR=1.53,95％CI:1.09～2.95);在以患者疾病背景为亚组的亚组分析中,高血压患者可在所有五个模型中发现较强的联系;在以年龄为亚组的亚组分析中,年龄≥65岁的患者可以在隐性基因模型和共显性基因模型中发现较强联系.研究中未发现有明显发表偏倚.结论 ACE I/D基因多态性是房颤发病的一个重要危险因素,DD基因型总体上可增加患者房颤发病风险,特别是在高加索人和高血压患者中,同时DD基因型可明显增加65岁以上病例房颤的发病风险,但在65岁以下病例中并未增加其房颤发病风险.%Objective To evaluate the impact of angiotensin converting enzyme (ACE) I/D polymorphism on the risk of atrial fibrillation (AF).Methods Eligible studies about the impact of ACE I/D polymorphism on the risk of atrial fibrillation were searched in PubMed, Web of Science, Google Scholar, CNKI and Wanfang from when the databases established to 2016.3. STATA 12.0 is used to statistically analyze the relevant articles. The associations between ACE I/D polymorphism and AF risk were estimated by pooled odds ratio (OR) and 95％ confidence interval (CI) using a fixed or random-effects model. Publication bias was also calculated. Subgroup analysis and sensitivity analysis are used to find the possible source of heterogeneity. And subgroup analyses are conducted with respect to ethnicity, AF type and age.Results A total of 20 studies which evaluated the association between ACE I/D polymorphisms and AF were included, with 3006 cases and 4861 controls. The pooled OR was 1.22 (95％CI:0.97～1.52) for dominant model, 1.22 (95％CI: 1.04～1.43) for allele model, 1.41 (95％CI: 1.11～1.98) for recessive model, 1.48 (95％CI: 1.11～1.98) for additive model, 1.36 (DDvs. DI, 95％CI: 1.09～1.70) and 1.12 (DIvs. II, 95％CI: 0.89 to 1.39) for codominant gene model, respectively. In subgroup analysis, a strong association was found in Caucasians in recessive model (OR=1.53, 95％CI: 1.09～2.95). Strong associations were also found in hypertensive patients of all five models and subjects ≥ 65-year-old of recessive model and co-dominant model. No publication bias was found in this study.Conclusion ACE I / D polymorphism is an important risk factor for the onset of atrial fibrillation. DD genotype significantly increases the risk of atrial fibrillation, especially in the Caucasus and hypertensive patients. Meanwhile, DD genotype significantly increase AF risk in patients over 65 years old, but no association was observed in patients below 65 years old.