心衰患者心室重构药物干预效果与基因多态性的相关性
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【摘要】 目的 观察血管紧张素转换酶(ACE)基因多态性对药物干预充血性心力衰竭(CHF)患者心室重构的影响。方法 选择56例CHF患者,随机分为对照组(强心剂、利尿剂、硝酸酯类药物)28例;治疗组(常规治疗+美托洛尔+依那普利)28例,均连续治疗三个月。所有受试者进行ACE基因分型,治疗前后进行超声心动图测量左室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)和左心室射血分数(LVEF)。结果 治疗3个月后,两组治疗均有效,但治疗组中ACE DD基因型患者LVEDD、LVEDV明显低于ID型、II型及对照组,而LVEF明显增高, P<0.01。结论 在常规治疗基础上加用依那普利和美托洛尔治疗心力衰竭效果更好,但是不同ACE基因型间治疗效果有差异。
关键词 血管紧张素转换酶;基因多态性;心力衰竭;心室重构;依那普利;美托洛尔
The relationship between effect of drug intervention on ventricular remodeling in patients with congestive heart failure with ACE gene polymorphism.Zhang Hua,Li Jing,Liu Wei-chang.Zou Ping Country People’s Hospital,Shan Dong, China, 256200.
Abstract Objective To investigate the relationship between ACE gene polymorphism and the effects of ACEI andβ-B on the patients with CHF.Methods 1. Choose 56 cases with CHF were divided randomly into control group(n=28 ,treated with digitals, diuretics,nitrates) and treating group (n=28,enalapril combined with metoprolo ) .Both of groups were treated for three months.2. With Doppler ultra-sonic apparatus, the size of LVEDD, LVEDV and LVEF in 56 patients were measured.All of patients were determine the type of ACE gene.Results After treatment, left ventricular structure and its function had been improved in both of groups, spcially in treating group. And in treating group, LVEDD and LVEDV were lower in ACE DD genotype compared with ID genotype, II genotype, while LVEF was higher than them (P<0.01).Conclusions On the basis of the routine therapy ,the use of enalapril and metoprolol can remarkably the left ventricular structure and its function of patients with CHF.And this effect has relationship with ACE gene polymorphism.
Keywords angiotensin-convertion enzyme; gene polymorphism; congestive heart failure; Enalapril; Metoprolol
心室重构是导致CHF发生发展的基本机制,在实际治疗过程中,患者对ACEI及β-B治疗效果的个体差异很大,产生这种个体差异的原因与ACE基因型有关[1、2]。探讨ACE基因多态性对CHF心室重构治疗效果的影响,了解不同基因型对ACEI及β-B敏感性的差异,对预防和治疗心室重构,改善CHF患者预后具有重要的意义。
1 资料与方法
1.1研究对象
选择2008年6月-2009年8月在我院心内科住院和门诊的56例患者,男41例,女15例,年龄62岁-80岁。CHF诊断标准参照Framingham标准。心功能按NYHA分级,超声心动图 LVEF<50%,心功能II级11例,III级38例,IV级7例。将56例CHF患者随机分为对照组28例,其中男20例,女8例;治疗组28例,其中男21例,女7例。剔除合并近1个月内急性心肌梗死、有禁忌症不能使用或耐受ACEI和β-B,1周内使用ACEI、β-B、ARB者、严重肝肾功能不全、严重急性感染或代谢紊乱、急性心力衰竭者。
1.2用药方法:
对照组:28例,强心剂、利尿剂、硝酸酯类药物。禁用ACEI、ARB、β-B。治疗组:28例,常规治疗基础上加用美托洛尔12.5mg-25mg,bid,依那普利5mg-10mg,qd,连用3个月。
1.3观察指标:
所有受试者用PCR方法检测ACE基因多态性,治疗前后有同一超声医生使用彩色多普勒超声仪,测量LVEDD、LVEDV,并计算LVEF ......
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