ACE基因多态性与缬沙坦治疗房颤合并心功能不全患者疗效的相关性

目的探讨血管紧张素转化酶(ACE)基因多态性与缬沙坦治疗房颤合并心功能不全患者疗效的关系。方法选取2017年1-12月在我院接受缬沙坦治疗的持续性房颤合并心功能不全患者,共82例。收集年龄、性别、体重及入院时心功能指标,并检测分析ACE I/D、G2350A基因多态性,比较不同位点基因分型与缬沙坦治疗效果的关系。结果随着治疗后随访时间的延长,ACE I/D基因中DD、II基因型患者窦性心律维持率明显下降(P<0.05)。与ACE ID型、DD型比较,II型治疗后9、12个月窦性心律维持率均显著升高(P<0.05);ACE G2350A基因中GG、GA基因型患者窦性心律维持率明显下降(P<0.05)。与ACE GG型、GA型比较,AA型治疗后12个月窦性心律维持率均显著升高(P<0.05)。与复发患者比较,未复发患者心功能、LVEF、BNP以及ACE G2350A基因中AA基因型比例和I/D基因中II基因比例明显升高,SBP明显下降(P<0.05)。BNP是房颤复发的独立危险因素,心功能分级(Ⅱ级)、I/D位点基因分型(II)、G2350A位点基因分型(AA)则是保护因素(P<0.05)。结论 ACE I/D基因和G2350A基因多态性与缬沙坦治疗房颤合并心功能不全患者疗效密切相关,且2个位点的基因多态性之间可能存在一定协同作用,可为个性化临床用药方案的确定提供新的科学依据。

Correlation between ACE gene polymorphism and the efficacy of valsartan in the treatment of patients with atrial fibrillation and cardiac insufficiency

Objective To explore the correlation between angiotensin converting enzyme(ACE)gene poly-morphism and the efficacy of valsartan in the treatment of patients with atrial fibrillation and cardiac insufficiency.Methods A total of 82 patients with persistent atrial fibrillation complicated with cardiac dysfunction who received valsartan treatment in our hospital from January to December in 2017 were selected.Age,gender,weight,and cardiac function at admission were collected,and the polymorphism of ACE I/D and G2350A genes was detected and analyzed,and the relationship between different genotypes and valsartan treatment effect was compared.Results With the exten-sion of follow-up time after treatment,sinus rhythm maintenance rate of DD and II genotypes in ACE I/D gene was sig-nificantly decreased(P<0.05);compared with ACE ID and DD,sinus rhythm maintenance rates of II were significant-ly increased at 9 and 12 months after treatment(P<0.05).With the extension of follow-up time after treatment,sinus rhythm maintenance rate of GG and GA genotypes in ACE G2350A gene was significantly decreased(P<0.05);com-pared with ACE GG and GA,sinus rhythm maintenance rate of AA was significantly increased at 12 months after treat-ment(P<0.05).Compared with patients with recurrence,the proportion of AA in G2350A gene and II in I/D gene,heart function,LVEF and BNP in patients without recurrence were significantly increased,while SBP was significantly decreased(P<0.05).BNP was an independent risk factor for atrial fibrillation recurrence,while cardiac function gradeⅡ,I/D genotyping(II)and G2350A genotyping(AA)were protective factors(P<0.05).Conclusion ACE I/D and G2350A gene polymorphism is closely related to valsartan's efficacy in the treatment of patients with atrial fibrillation complicated with cardiac insufficiency,and there may be a synergistic effect between the two loci of gene polymor-phism,which can provide a new scientific basis for the determination of personalized clinical drug regimen.