血管紧张素转换酶基因多态性与缺血性脑卒中后3个月认知的关系

目的探讨血管紧张素转换酶(ACE)基因插入/缺失(I/D)多态性与缺血性脑卒中后3个月非痴呆认知功能障碍(CIND)的关系。方法初发缺血性脑卒中患者185例,根据脑卒中后3个月认知功能测定将患者分为CIND组(42例)和对照组(143例)。PCR法测定ACE基因I/D多态性,采用简易智能状态量表和美国精神疾病统计和诊断手册第4版修订本进行认知测定。结果 CIND组与对照组ACE基因I/D多态性的基因型分布与Hardy-Weinberg平衡的理论频数之间差异无统计学意义。单因素分析发现,ACE基因DD基因型人群CIND发病风险是Ⅰ等位基因携带者的2.460倍(95% CI:1.084～5.582,P0.05)。多因素logistic回归分析发现,在共显性模式中,DD基因型人群CIND发病风险是Ⅱ基因型的3.185倍(95% CI:1.148～8.842,P0.05);在隐性遗传模式中,DD基因型人群CIND发病风险是Ⅰ等位基因携带者的2.852倍(95% CI:1.058～7.687,P0.05)。结论ACE DD基因型是缺血性脑卒中后CIND的独立危险因素,携带ACE DD基因型的患者可能更易发生CIND。

Relation between ACE gene I/D polymorphism and cognitive impairment at 3 months after ischemic stroke

Objectives To determine the relation between ACE gene I/D polymorphism and cognitive impairment no dementia(CIND) after ischemic stroke.Methods The perspective nested case-control design was applied to the study.The sample consisted of 185 Han people with first-ever ischemic stroke.The ACE gene I/D polymorphism was detected by PCR according to the presence of the intron 16 specific insertion or deletion fragments,490 kb and 190 kb respectively(Rigat' s methods),and the possible risk factors involved in CIND were collected in detail.The cognitive function was evaluated at 3 months after stroke according to the Chinese version of MMSE and DSM-Ⅳ-R.CIND was established if a patient with cognitive impairment did not fulfill the DSM-Ⅳ-R criteria of dementia.Results The distribution of genotypes and alleles of ACE gene I/D polymorphism fit Hardy-Weinberg equilibrium in both CIND and control groups.Univariate analysis found that the risk for CIND in patients with ACE DD genotype increased by 2.460 times CDD vs Ⅰ-carrier,P <0.05) compared with control subjects.Multivariate logistic regression analysis suggested that the subjects with ACE DD genotype were associated with an increased risk of CIND in recessive model (OR = 2.852,95% CI:1.058 - 7.687,P < 0.05) or in additive model (OR = 3.185,95% CI:1.148-8.842,P< 0.05).Conclusions ACE DD genotype was independently associated with CIND after ischemic stroke.The ischemic stroke patients carrying ACE DD genotype might be susceptible to CIND.