冠心病患者血管紧张素转换酶基因插入/缺失多态性分析

应用多聚酶链反应（PCR）方法对72例心肌梗塞（MI）患者、32例冠状动脉粥样硬化（CAD）患者和72例非冠心病患者血管紧张素转换酶（ACE）基因插入／缺失（I／D）多态性进行比较。结果表明，MI和CAD患者ACE基因DD型显著高于对照组（分别为0．44、0．50和0．21），但与冠状动脉狭窄程度无关。DD型ACE基因可能是中国人冠心病发病的独立危险因子。     

血管紧张素转换酶和血管紧张素Ⅱ-1型受体基因多态性与冠心病的相关性分析

目的研究血管紧张素转换酶（ACE）基因I／D多态性和血管紧张素Ⅱ-Ⅰ型受体（AT1R）基因A1166／C多态性与冠心病（CHD）的关系。方法采用聚合酶链反应-限制性片段长度多态性（PCR—RFLP）技术检测130例CHD组和90例对照组ACE和AT1R基因多态性。结果ACE—DD基因型频率在CHD组显著高于对照组（38．5％，14．4％，P〈0．001）。AT1R—AC基因型在两组间差异无显著性（13．1％，10％，P〉0．05），但合并AC基因型的DD型患者发生CHD和MI的OR值（5．836和3．985）明显高于合并AA型（3．102和2．979）。结论ACE基因I／D多态性中DD基因型是冠心病发病的独立危险因素之一，AT1R—C等位基因增加ACE—DD型发生CHD和MI的危险，二者具有协同作用。     

血管紧张素转换酶和血管紧张素原基因多态性与冠心病的关系

目的探讨血管紧张素转换酶（ACE）插入／缺失（I／D）多态性和血管紧张素原（AGT）M235T基因多态性与冠心病（CHD）的关系。方法应用多聚酶链反应结合限制性内切酶法（PCR—RFLP）对110例冠心病患者、62例冠状动脉造影正常者以及18名门诊常规体检无冠心病史者基因多态性进行分析。结果①CHD组ACE基因DD基因型及D等位基因频率明显高于健康对照组（分别为43．6％、60．5％比26．3％、44．4％）,差异有统计学意义‘P〈0．05）。CHD组AGT基因TT基因型及T等位基因频率明显高于对照组（分别为66．4％、78．6％比42．5％、60．6％）,差异有统计学意义（尸〈0．05）。②男性CHD组ACE基因DD基因型和D等位基因频率以及AGT基因TT基因型和T等位基因频率均显著高于对照组（均P〈O．05）。女性CHD组ACE基因DD基因型和D等位基因频率以及AGT基因‘rr基因型和T等位基因频率与对照组比较差异无统计学意义（P〉0．05）。③联合分析ACEDD型及AGTTr型罹患冠心病的相对风险,其比数~L（OR）为4．904,高于单基因ACEDD型（2．175）及AGTTT型（2．669）。结论ACE基因I／D多态性及AGT基因M235T多态性与CHD有显著相关性,同时具有ACEDD型及AGT TT型发生冠心病的相对风险显著高于单基因ACEDD型及单基因AGT‘丌型。性别也可作为冠心病的危险因素。     

血管紧张素转换酶基因多态性与心肌梗塞发病相关性研究

对104例正常人和97例心肌梗塞患者用PCR方法检测其ACE基因型及血清ACE水平。ACE基因多态性分为DD、ID、II型。结果表明等位基因频率D=0.56,I=0.44,三种基因型之间血脂、脂蛋白、血糖、胰岛素、BMI等无差异。DD、ID、II型ACE水平分别为38.35±10.24u、30.74±9.6u、29.03±5.26u(P<0.01)。ACE DD型与心肌梗塞相关,D等位基因频率梗塞组高于对照组,OR值为1.55(P=0.003)。在低危人群中DD基因型频率梗塞组高于对照组,DD基因型与梗塞的相关性增高,OR值由1.55增高为1.65、1.69。有冠心病家族史者其DD基因型频率高于无冠心病家族史者,OR为1.87(P=0.02)。因此,ACE I/D基因多态性与血清ACE水平相关,ACE DD是冠心病、心肌梗塞的潜在危险因素,尤其对于低危人群。     

血管紧张素I转换酶基因I／D多态性与特发性肺纤维化的相关性研究

目的探讨血管紧张素I转换酶（ACE）基因I／D多态性在特发性肺纤维化（IPF）发病中的作用。方法应用PCR技术检测42例IPF患者（IFP组）和90例健康查体者（对照组）ACE基因I／D多态性,并分析不同基因型和等位基因者IPF发病危险性。结果IPF组DD基因型和D等位基因频率均显著高于对照组（P〈0．05）;与Ⅱ基因型比较,携带DD型和D等位基因个体发生IPF的风险分别增加2．97倍（95％CI为1．13—7．73）和1．96倍（95％CI为1．16—3．32）,P均〈0．05。结论ACE基因I／D多态性与IPF发病有关,DD基因型和D等位基因可能增加IPF的患病风险。     

冠心病患者血管紧张素转换酶基因多态性及其与血清血管紧张素转换酶水平的关系

为研究冠心病患者血管紧张素转换酶（ＡＣＥ），基因插入／缺失（Ｉ／Ｄ）多态性分布及其血清ＡＣＥ水平的相关性，应用多聚酶链反应方法测定了６１例冠心病患者和６３例健康人群的ＡＣＥ水平，结果发现，冠心病患者ＡＣＥ基因ＤＤ型出现频率显著对照组，且ＤＤ基因型者具有较高的血清ＡＣＥ水平，提示，ＡＣＥ基因Ｉ／Ｄ多态性与血清ＡＣＥ水平密切相关，ＤＤ型ＡＣＥ基因可能是中国人冠心病发病的独立危险因子。     

血管紧张素转换酶基因多态性与原发性高血压病

血管紧张素转换酶基因存在数种多态性标志,其第16内含子多聚酶链反应扩增产物可形成3种多态性：Ⅱ型、DD型及I／D型。DD型者血浆ACE浓度、血压高于I／D及Ⅱ型,D等位基因与高血压并发症密切相关,血管紧张素转换酶基因I／D多态性影响着原发性高血压病的发生、发展及预后。     

血管紧张素转换酶基因多态性与2型糖尿病肾病的相关性

应用PCR技术检测144例2型糖尿病患者（T2DM组）的血管紧张素转换酶（ACE）基因插入/缺失（I／D）多态性,并与67例健康人（对照组）比较,结果两组间ACE等位基因、基因型频率无显著性差异（P〉0．05）;T2DM组伴DN者（80例）DD基因型频率显著高于不伴DN者（64例）（P〈0．05）;DN患者中肾功能不全者DD基因型及D等位基因频率均明显高于肾功能稳定者（P〈0．05）。提示ACE基因I／D多态性与T2DM的易感性无关,与DN的发生、发展密切相关。     

血管紧张素转化酶基因多态性与老年人高血压合并左心室肥厚的探讨

目的 探讨血管紧张素转化酶（ACE）基因插入／缺失（I／D）多态性与老年人高血压合并左心室肥厚（LVH）的关系。同时测定血清ACE水平,观察与ACE基因多态性的关系。方法 应用聚合酶链反应（PCR）技术102例老年人进行ACE基因I／D多态性检测,其中正常对照者41例,高血压无心脑血管合并症（CCVD）患者35例,高血压合并LVH者26例。同时,用紫外分光光度法测定其中32例正常人和29例高血压病患者的血清ACE浓度。结果 高血压合并LVH组DD基因型频率0．385和D等位基因频率0．596分别显著高于正常对照组的0．122和0．378（均为P＜0．05）,以及高血压无CCVD组的0．114和0．386（均为P＜0．05）。同时发现DD型者血清ACE水平显著高于Ⅱ型（P＜0．05）。结论 ACE基因缺失多态性可能是老年高血压合并LVH易患者的重要遗传标志。     

心肌梗死家系血管紧张素转换酶基因多态性与胰岛素抵抗关系的研究

目的：探讨心肌梗死家系成员不同ACE基因型与胰岛素抵抗（ISR）的关系及二在冠心病发病中的作用及其临床意义。方法：将27个合格心肌梗死家系成员分为三组：冠心病组74例，一级亲属健康组86例，健康对照组74例。应用多聚酶链反应方法对各组ACE基因插入／缺失（I／D）多态性进行检测，应用放免法及生化技术测量血清胰岛素、血糖、血脂，通过口服葡萄糖耐量实验结果计算ISR值。对各组计数指标采用t检验进行比较，对各组基因型频率采用χ^2检验，对各临床指标与ACE基因型及冠心病的发病关系采用logistic回归进行统计分析。结果：与对照组比较，心肌梗死家系中冠心病组缺失等位基因DD基因型频率显高于对照组（χ^2=6.3,P＜0．05），而一级亲属健康组与对照组比较无显性差异（χ^2=1.2,P＞0．05）。家系中包括一级亲属健康组在内的各组成员的ISR值、血清总胆固醇、甘油三酯水平均高于对照组（P＜0．05），但各基因型之间的ISR值、血脂各项无显性差异（P＞0．05）。多因素分析结果显示ACE基因型、ISR、血脂与冠心病发病密切相关。结论：在心肌梗死家系这个特殊人群中，ACE基因I／D多态性及ISR均是冠心病发病的独立危险因素，但ACE基因对冠心病的作用并非通过ISR实现的。     

血管紧张素转化酶基因插入/缺失多态性与冠心病发病的关系

目的 :探讨血管紧张素转化酶 (ACE)基因多态性与冠心病 (CHD)发病的关系。方法 :以人基因组DNA为模板 ,应用聚合酶链式反应 (PCR)检测 5 0例CHD组和 5 6例正常对照组ACE基因第 16内含子插入 /缺失 (I/D)多态性 ,并按性别分组计算各组基因型和等位基因频率。结果 :①在CHD组中 ,ACE基因DD基因型和D等位基因频率分别为 36 %和 6 0 % ,正常对照组分别为 16 %和 4 1% ,两者相比差异有统计学意义 (P <0 .0 1)。②男性CHD组DD基因型和D等位基因频率均显著高于对照组 (均P <0 .0 5 )。女性CHD组DD基因型频率显著高于对照组 (P <0 .0 1) ,D等位基因频率与对照组比较差异无统计学意义。结论 :CHD与ACE基因I/D多态性有显著相关性 ,不论男性和女性 ,ACE基因DD基因型均可能是CHD发生发展过程中重要的危险因素之一。     

高血压人群中ACE、ADRB1基因多态性与冠状动脉狭窄程度的相关性研究

目的探讨高血压人群中血管紧张素转换酶(ACE)基因多态性及β1肾上腺素能受体(ADRB1)基因多态性与冠状动脉(冠脉)狭窄程度的相关性。方法选取2017年7月至2019年4月于徐州医科大学附属医院心血管内科住院的280例高血压患者的临床资料进行回顾性分析,行冠脉造影或冠脉CT血管造影(CTA)检查判定其是否患有冠心病(CHD),并依据结果判定其冠脉病变支数及给予Gensini评分。根据冠脉检查结果将上述患者分为CHD组(n=145)和对照组(n=135)。所有入选病例均给予了ACE及ADRB1基因多态性检测,并根据结果分为ACE II型纯合子、ID型杂合子、DD型纯合子和ADRB1 GG型纯合子、GC型杂合子、CC型纯合子。结果在研究的高血压人群中,ACE DD基因型携带者在冠脉病变支数中的多支病变组及Gensini得分分组中的重度病变组的占比明显高于ACE II及ACE ID基因型(P<0.05);ADRB1基因多态性在冠脉病变支数分组及Gensini得分分组的对比中无明显相关性(P>0.05);CHD组与对照组一般临床资料对比中显示年龄、高密度脂蛋白胆固醇(HDL-C)和糖尿病与CHD存在相关性,且有统计学意义(P<0.05)。结论ACE基因多态性与高血压人群冠状动脉狭窄程度密切相关,ADRB1基因多态性无明显相关性。     

血管紧张素转换酶基因多态性对冠心病患者血管内皮舒张功能的影响

目的:观察血管紧张素转换酶(ACE)基因多态性对冠心病患者内皮功能的影响及其抑制剂的干预作用.方法:选取冠心病患者(冠心病组)68例,对照组69例,聚合酶链反应(PCR)检测ACE基因插入/缺失(L/D)多态性,超声检测肱动脉内皮功能.结果:冠心病组DD基因型明显高于对照组.冠心病组ACE各基因型内皮依赖性舒张功能均低于对照组,DD基因型最为明显;非内皮依赖性舒张功能差异无显著性.血管紧张素转换酶抑制剂(ACEI)治疗后冠心病组各型肱动脉内皮依赖性舒张功能与治疗前比较均有显著性改善,其中DD基因型改善最为明显.结论:冠心病患者血管内皮功能异常与ACE基因I/D多态性相关.ACEI可以改善内皮功能,特别是对DD基因型患者改善更为明显.     

ACE gene polymorphism and coronary restenosis.

In humans, circulating levels of angiotensin-converting enzyme (ACE) are linked with an insertion (I)/deletion (D) polymorphism in the ACE gene: DD genotype bearers have higher levels of ACE than either ID or II genotype bearers. Recent studies have suggested that the ACE DD genotype might be associated with a higher risk of coronary artery disease. The aim of this paper is to review studies on the influence of the I/D polymorphism on coronary restenosis. The renin-angiotensin system has been implicated in the pathogenesis of neointimal hyperplasia in experimental models. In humans, the I/D polymorphism is not associated with restenosis after balloon angioplasty, but is strongly associated with restenosis after coronary stent implantation. This may be explained by the fact that the contribution of neointimal hyperplasia to restenosis is much more important after coronary stent implantation than after balloon angioplasty.     

Angiotensin I-converting enzyme (ACE) inhibitors and restenosis after coronary artery stenting in patients with the DD genotype of the ACE gene

OBJECTIVES: We tested the hypothesis that patients with the DD genotype of the angiotensin I-converting enzyme (ACE) gene who are treated with ACE inhibitors are at a higher risk of restenosis after coronary stent placement than patients who do not receive ACE inhibitors. BACKGROUND: Two recent studies with a limited series of patients carrying the DD genotype suggested an unfavorable impact of the use of ACE inhibitors on the restenotic process after implantation of stents in coronary arteries. Because these findings may question the use of ACE inhibitors after coronary stenting, we examined this important issue in a large series of patients. METHODS: We determined the ACE gene I/D genotype of 2,222 consecutive patients with symptomatic coronary artery disease who underwent stent implantation. The patients with the DD genotype (n = 612) constituted the study population. The primary end point was in-stent restenosis, which was assessed as angiographic restenosis (> or =50% diameter stenosis at six-month follow-up) and clinical restenosis (need for target vessel revascularization due to symptoms or signs of ischemia in the presence of angiographic restenosis over one year after the intervention). RESULTS: Of the 612 patients with the DD genotype, 403 (65.8%) were treated with ACE inhibitors and 209 (34.2%) did not receive ACE inhibitors. The angiographic and clinical restenosis rates were not significantly different between the group treated with ACE inhibitors and the group not receiving ACE inhibitors (p = 0.55). Continuous measures of restenosis, minimal lumen diameter, diameter stenosis, late lumen loss, and loss index were also similar in both groups (p > or = 0.55). In addition, one-year survival free of myocardial infarction was not significantly different between the two groups (p = 0.27). CONCLUSIONS: In contrast to previous reports, our study provides evidence that patients carrying the DD genotype are not exposed to an increased risk of restenosis after stent placement when treated with ACE inhibitors.     

Angiotensin converting enzyme gene polymorphisms and coronary risk in a Portuguese population]

BACKGROUND: A family history of coronary heart disease (CHD) is a strong risk marker for the disease, independently of classical risk factors. It could be decoded by recognizing the polymorphisms associated with increased risk. Renin-angiotensin system genes are candidate genes in CHD and the deletion allele of the angiotensin converting enzyme (ACE) has been reported as deleterious. However, there is disagreement as to the role of the insertion/deletion polymorphism of the ACE gene in coronary risk. AIM: To evaluate whether ACE gene polymorphisms constitute a CHD risk factor. METHODS: We conducted a population-based case-control study of 301 subjects with a history of myocardial infarction or angiographic evidence of coronary heart disease and 510 age- and gender-matched controls, without CHD, living in a region with high CHD mortality rates. Blood samples were taken, DNA extracted and genotypes determined by the polymerase chain reaction (PCR). Amplification products were identified by agarose gel electrophoresis. STATISTICAL ANALYSIS: The Data were evaluated by SPSS for Windows, using the Student's t test, the chi-square test, odds ratios and 95% confidence intervals. RESULTS: The prevalence of the DD, ID and II genotype was 41.2%, 46.3%, 12.5% in the cases and 28.1%, 55.2% and 16.7% in the control group. The frequency of the DD genotype was significantly higher in the cases than in the controls (41.2% vs. 28.1%, odds ratio 1.79, 95% CI 1.31 to 2.4, p < 0.0001). By contrast, the ID and II genotypes' prevalence was higher in the control group (55.2% vs. 46.3%, p = 0.002 and 16.7 vs. 12.5%, p = NS, respectively) compared to the case group. CONCLUSIONS: This study clearly shows that the ACE DD polymorphism is strongly linked to CHD, and if our data are confirmed in a larger population sample, more aggressive vascular prevention could be justified in patients carrying the DD genotype.     

Renin-angiotensin system gene polymorphisms: assessment of the risk of coronary heart disease

BACKGROUND: Renin-angiotensin system genes are candidate genes in cardiovascular system diseases. Angiotensinconverting enzyme (ACE), angiotensinogen (AGT) and angiotensin II type 1 receptor (AT1R) gene polymorphisms are considered risk factors in coronary heart disease (CHD). AIM: To evaluate the involvement of the ACE, AGT and AT1R genetic variants in predisposition to CHD as well as their association with other known risk factors. METHODS: The study included 400 male subjects (200 with CHD and 200 healthy individuals). Genotypes were determined by a polymerase chain reaction (PCR). For the AGT and AT1R genes a restriction analysis of the PCR product was performed. The allele frequency and genotype distribution were compared between groups. RESULTS: The allele and genotype frequencies of the ACE gene were similar in both groups, however, a significantly higher frequency of the DD genotype was observed in the presence of hyperlipidemia (39% vs 24% in non-hyperlipidemic subjects, p<0.01). The AGT gene polymorphism was associated with the development of CHD. The T allele was significantly more frequent in patients than in the control group (55% vs 44%, p<0.05). The heterozygous MT genotype was observed in 61% of patients compared to 40% in the controls (p<0.05). The A1166C polymorphism of the AT1R gene was also associated with CHD as well as with age at the onset of disease. The frequency of the C allele was 29% compared to 21% in the control group (p<0.01) and the frequency of the CC homozygote was almost three times higher in patients. CONCLUSIONS: There is an association between molecular variants of the angiotensinogen and angiotensin II type 1 receptor and increased risk of CHD. The DD genotype of the ACE gene polymorphism and the TT genotype of the AGT gene polymorphism were significantly more frequent in patients with hyperlipidemia. The TT genotype of the AGT gene M235T polymorphism was associated with an increased risk of CHD and myocardial infarction only in smokers.     

血管紧张素转换酶基因多态性与冠脉病变严重程度的相关性研究

目的探讨血管紧张素转换酶(ACE)基因I/D多态性与冠心病及冠脉病变严重程度的关系.方法对122例冠心病患者进行冠状动脉造影,判定冠脉病变支数(狭窄程度≥75%)和危险记分.用聚合酶链式反应(PCR)技术检测病例组和80例健康人群ACE基因多态性.结果ACE基因型分布和等位基因频率在病例组和对照组间差异有显著性,病例组DD基因型(38.5%)和D等位基因频率(55%)显著高于对照组(13.7%,41%;P＜0.05).冠脉病变支数和危险记分在ACE基因型间差异无显著性(P＞0.05).结论ACE基因多态性中DD型和D等位基因是冠心病发病的独立危险因素,但与冠脉病变严重程度不相关.