摘要
背景:动脉粥样硬化性脑梗死与载脂蛋白E、B基因多态性的研究有所报道,然而结果不尽相同。载脂蛋白E、B基因多态性与青年人动脉粥样硬化性脑梗死的相关性研究国内未见报道。目的:应用聚合酶链反应技术分析载脂蛋白E、B基因多态性对青年动脉粥样硬化性脑梗死发病的意义及其相关性。设计:以青年动脉粥样硬化性脑梗死患者为研究对象,病例-对照分析。单位:中国医科大学盛京医院神经内科。对象:实验于1998-01/2000-12中国医科大学盛京医院完成。选取神经内科动脉粥样硬化性脑梗死患者36例作为脑梗死组,男30例,女6例,平均年龄(41.6±6.54)岁;对照组为100例体检健康的沈阳籍汉族青年,男66例,女34例,平均年龄(36.16±6.12)岁。方法:两组患者于空腹12h后抽取静脉血8mL,测定血清脂类及载脂蛋白。采用聚合酶链反应技术检测载脂蛋白E和载脂蛋白B的基因多态性;酶法测定血清总胆固醇、三酰甘油、高密度脂蛋白胆固醇含量;免疫比浊法测定血清载脂蛋白AI.B浓度;酶联免疫法测定血清脂蛋白a的含量。主要观察指标:①载脂蛋白E、B基因型频率在两组人群中的分布特征。②载脂蛋白E和载脂蛋白B基因多态性与血脂、脂蛋白和载脂蛋白的含量的关系。③载脂蛋白E、B基因型与青年人动脉粥样硬化性脑梗死发病中的关联强度。结果:①脑梗死组患者ε3/4型频率为36.1%,ε2/4型频率为27.7%;对照组分别为12%和7%;梗死组ε4等位基因频率为0.320,明显高于对照组的0.095(P<0.05)。②脑梗死组患者三酰甘油、总胆固醇、脂蛋白a含量明显高于对照组,高密度脂蛋白胆固醇含量显著低于对照组(P<0.05～0.001)。③ε4等位基因使血清三酰甘油、总胆固醇、血清脂蛋白a含量增高、致高密度脂蛋白胆固醇含量降低的相对风险率依次为8.23,4.85,4.39,29.9(P<0.01～0.001)。④载脂蛋白B基因XbaⅠX+X-亚组的载脂蛋白AⅠ含量为(1.01±0.30)g/L,明显低于X-X-亚组的(1.33±0.15)g/L(t=2.55,P<0.05);X+X-亚组的血清脂蛋白a含量为244.3mg/L,与对照组的含量183.0mg/L相比,差异有显著性意义(t=4.50,P<0.01)。⑤脑梗死组患者中ε3与X+X-同时存在者3例,与X-X-同时存在10例;ε4与X+X-同时存在者2例,与X-X-同时存在19例,ε4与X-X-并存时动脉粥样硬化性脑梗死发病风险率为2.85(χ2=1.52,P>0.05)。结论:载脂蛋白E等位基因ε4是青年人动脉粥样硬化性脑梗死的一种遗传易感性因子;XbaⅠX+X-可能是另一种遗传标记;载脂蛋白E与载脂蛋白B基因型并存时与年青人动脉粥样硬化性脑梗死的关系需进一步研究。
BACKGROUND; There are some reports about the relationship between atherosclerotie cerebral infarction and apolipoprotein E and B, but the results are still controversial. The relationship between apolipoprotein E and B and young adult atherosclerotie cerebral infarction has not been reported yet in China.
OBJECTIVE： To investigate the relationship between the polymorpbism of apolipoprotein E and B gene and young adults atheroselerotie cerebral infarction （ACI）.
DESIGN： A controlled ease analysis of young adult atherosclerotie cerebral infarction patients.
SETTING： Department of Neurology, Shengjing Hospital of Chinese Medical University.
PARTICIPANTS： This study was conducted in the Department of Neurology, Shengjing Hospital of Chinese Medical University from January of 1998 to December of 2000. Thirty-six young adult patients with atherosclerotie cerebral infarction, including 30 males and 6 females, with the mea age of （41.6±6.54） years, and 100 healthy young adults, including 66 males and 34 females, with the mea age of （36.16±6.12） years were included in this study.
METHODS： 8 mL venous blood was collected after fasting for 12 hours to assay serum lipid and apolipoprotein. The gene polymorphism of apolipoprotein E and B were detected with PCR method. Enzymic method was used to detect total cholesterol, total triglyeerides and high density lipoprotein-eholesterol （HDL-C）. Apolipoprotein ALB was measured with immunoturbidimetry method and lipoprotein （a） with ELISA method. Lipids, lipoprotein and apolipoprotein of six control blood samples couldn＇t be measured because of hematolysis.
MAIN OUTCOME MEASURES： ①The distribution characteristics of genotypie frequency of apolipoprtein E and B in the two groups. ②The relationship between gene polymorphism of aoplipoprotein E and B and the level of blood lipids, lipoprotein and apolipoprotein. ③ The correlation intensity between genotypes of apolipoprotein E and B and onset of young adult atherosclerotie infarction.
RESULTS： ①In ,ACI group, ε3/4 counted for 36.1% and ε2/4 for 27.7%, but was 12% and 7% in control group respectively. The gene frequency of ε4 was 0.320. All these values were higher than that in control group 0.95 （P 〈 0.05）. ② The levels of TG, TC, and LP （a） in ACI group were higher than that in control group, The level of HDL-C was much lower than the control group＇s （P 〈 0.05-0.01）. ③ε4 allele caused the increase of the content of TG, TC, and LP （a） so as to induce the relative risk rates of decrease of HDL-C which were 8.23, 4.85, 29.9, 4.39 （P 〈 0.01-0.001） respectively. ④ AI content of the gene frequency of ApoB Xbal X^＋X^- was （1.01±0.30） g/L in ACI group, which was lower than （1.33±0.15） g/L in X^＋X^- subgroup （t=2.55, P 〈 0.05）. The level of ApoA Ⅰ in X^＋X^- group （244.3 mg/L） was remarkably different from that （183.0 mg/L） in control group （t=4.50, P 〈 0.01）. ⑤Three cases had both ε3 and X^＋X^- in ACI group, 10 had both ε3 and X^＋X^-, 2 had both ε4 and X^＋X^- , and 19 had both 64 and X^＋X^-. The risk of ACI was 2.85 with the linkage of allele ε4 and allele X^＋X^- in ACI patients （x^2=1.52, P 〉 0.05）.
CONCLUSION： Allele ε4 is a genetic facilitated factor of young adults ACI. Xba Ⅰ X^＋X^- is another probable genetic symbol. The correlation between atheroselerotie cerebral infarction of young patients during the combination of apolipoprotein E and B should be researched further.
出处
《中国临床康复》
CSCD
北大核心
2006年第4期172-175,共4页
Chinese Journal of Clinical Rehabilitation
