血管紧张素Ⅰ转换酶基因多态性与慢性心力衰竭药物治疗效果

目的：探讨血管紧张素Ⅰ转换酶（ACE）基因多态性对慢性心衰治疗效果的影响。方法：79例慢性心衰患者，用多聚酶链式反应（PCR）进行ACE基因分型，得到II，ID，DD三种基因型。所有患者用放射免疫法测定AngⅡ水平，超声测定左室舒张末期内径（LVDD）、左室射血分数；经常规方法治疗后，复查上述指标，并比较不同ACE基因型的治疗效果。结果：DD型慢性心衰患者LVDD，AngⅡ水平较其余两型患者更大、更高，且治疗后AngⅡ水平的下降幅度最大（P<0.05）。结论：国人ACE I/D基因多态性与慢性心衰的治疗效果可能有关。DD型患者体内可能存在较高的内分泌激活水平，经相关的药物治疗后可能获得更有益的内分泌效应。

Effect of the polymorphism of the angiotensin-converting enzyme gene on the drug treatment in patients with chronic heart failure

OBJECTIVE: To investigate the effect of the insertion (I)/deletion (D) polymorphism of the angiotensin-converting enzyme (ACE) gene on the drug treatment in patients with chronic heart failure. METHODS: The genotype was determined by polymerase chain reaction (PCR) in 79 patients with chronic heart failure. Plasma Ang II levels that were assessed by radio-immunity assay (RIA), left ventricular end-diastolic diameters (LVDD) and left ventricular ejection fractions (EF) and that were studied with echocardiography were measured before and after the treatment. RESULTS: ACE gene DD polymorphism was associated with greater LVDDs [DD vs. ID (P <0.001), DD vs. II (P < 0.001)], higher plasma Ang II levels [DD vs. ID (P < 0.05), DD vs. II (P < 0.001)] and the greatest decreased magnitude of plasma Ang II levels after treatment [DD vs. ID (P < 0.05), DD vs. II (P < 0.001)]. CONCLUSION: In patients with chronic heart failure, ACE gene DD polymorphism might be a marker of a higher level of activation of the renin-angiotensin system (RAS). Patients with the DD allele would expect a greater beneficial effect on endocrine by the drug treatment including ACE inhibitor and beta-blocker.