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| ApoE基因多态性与冠心病病变范围及氯呲格雷抵抗的关系 |
| Relationship between ApoE gene polymorphism and extent of disease and clopidogrel resistance of coronary heart disease |
| 投稿时间：2021-01-18 |
| DOI：10.3969/j.issn.1000-0399.2021.12.008 |
| 中文关键词: 冠心病 载脂蛋白E基因 基因多态性 氯吡格雷抵抗 不良心血管事件 |
| 英文关键词: Coronary heart disease Apolipoprotein E gene Gene polymorphism Clopidogrel resistance Adverse cardiovascular events |
| 基金项目:河南省2019年科技攻关计划（项目编号：LHGJ20190119） |
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| 中文摘要: |
| 目的 探究载脂蛋白E （ApoE）基因多态性与冠心病患者病变范围及经皮冠状动脉介入（PCI）术后氯呲格雷抵抗的关系。方法 选取2017年9月至2019年9月河南大学第一附属医院心血管内科收治的116例冠心病患者（冠心病组），患者均经冠脉造影确诊且接受PCI术、应用氯吡格雷抗血小板治疗，另选取同期80例心内科普通轻症患者为对照组，比较冠心病组与对照组血脂水平、ApoE基因表型及等位基因频率，经logistic回归探究ApoE基因表型与冠心病相关性；分析不同ApoE基因表型冠心病患者血脂、冠脉病变范围及严重程度差异；评价患者PCI术后氯吡格雷抵抗（CR）情况，并比较CR组与非CR组ApoE基因表型及等位基因频率，经logistic回归探究ApoE基因表型与PCI术后CR相关性；随访1年，比较不同ApoE基因表型患者不良心血管事件、出血事件发生情况。结果 冠心病组TC、TG、LDL-C水平均高于对照组（P<0.05）。冠心病组E4表型构成比及等位基因ε4频率均高于对照组（P<0.05），与E3表型相比，E4表型发生冠心病的OR值为2.41（P<0.05）。冠心病ApoE基因E4表型组TC、LDC-C水平均高于E2、E3表型（P<0.05）；E4表型中，三支病变构成比50.00%明显高于单支病变的12.50%，差异有统计学意义（P<0.05）；E4表型冠脉病变严重程度Gensini积分高于E2、E3表型（P<0.05）。116例患者CR检出率31.90%，而CR组E4表型构成比及等位基因ε4频率均高于非CR组（P<0.05）；与E3表型相比，E4表型发生CR的OR值为2.58（P<0.05）。随访1年，E2、E3、E4表型患者PCI术后不良心血管事件、出血事件发生率比较差异均无统计学意义（P>0.05）。结论 冠心病患者ApoE基因E4表型比例增加，且与患者血脂、冠脉病变范围、病变严重程度以及PCI术后氯吡格雷抵抗有关。 |
| 英文摘要: |
| Objective To explore the relationship between apolipoprotein E (ApoE) gene polymorphism and extent of disease and clopidogrel resistance after percutaneous coronary intervention (PCI) in patients with coronary heart disease. Methods A total of 116 patients with coronary heart disease treated in department of cardiovascular medicine of the First Affiliated Hospital of Henan University were selected between September 2017 and September 2019 (coronary heart disease group), and they were diagnosed by coronary angiography and received PCI and clopidogrel antiplatelet therapy. Another 80 generally mild patients in department of cardiology during the same period were selected as control group. The levels of blood lipids and ApoE gene phenotypes and allele frequencies were compared between coronary heart disease group and control group. The correlation between ApoE gene phenotypes and coronary heart disease was explored by Logistic regression. The blood lipids and extent and severity of coronary artery disease were among among patients with coronary heart disease with different ApoE gene phenotypes. The clopidogrel resistance (CR) status was evaluated after PCI. ApoE genotypes and allele frequencies were compared between CR group and non-CR group, and the correlation between ApoE gene phenotypes and CR after PCI were explored by Logistic regression. After 1 year of follow-up, the occurrence of adverse cardiovascular events and bleeding events were compared among patients with different ApoE gene phenotypes. Results The levels of TC, TG and LDL-C in coronary heart disease group were higher than those in control group (P<0.05). The E4 phenotype composition ratio and allele ε4 frequency in coronary heart disease group were higher than those in control group (P<0.05). Compared with the E3 phenotype, the OR value of the E4 phenotype for coronary heart disease was 2.41 (P<0.05). The levels of TC and LDC-C of ApoE gene E4 phenotype group of coronary heart disease were higher than those of the E2 and E3 phenotypes. Among the E4 phenotype, the proportion of three-vessel disease was significantly higher than that of single-vessel disease (50.00% vs 12.50%) (P<0.05). Gensini score of severity of coronary artery disease of the E4 phenotype was higher than that of the E2 and E3 phenotypes (P<0.05). The detection rate of CR in 116 patients was 31.90%, and the E4 phenotype composition ratio and allele ε4 frequency in CR group were higher than those in non-CR group (P<0.05). The OR value of CR in E4 phenotype was 2.58 compared with that in E3 phenotype (P<0.05). Within 1 year of follow-up, there were no statistical differences in the incidence rates of adverse cardiovascular events and bleeding events among patients with E2, E3 and E4 phenotypes after PCI (P>0.05). Conclusions The proportion of ApoE gene E4 phenotype increases among patients with coronary heart disease, and it is related to the blood lipids, extent of coronary artery disease, disease severity and clopidogrel resistance after PCI. |
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