ASSOCIATION BETWEEN ANGIOTENSIN-CONVERTING ENZYME GENE POLYMORPHISM AND LEFT VENTRICULAR REMODELING AFTER MYOCARDIAL INFARCTION

血管紧张素转换酶基因多态性与心肌梗死后左心室重构的相关性

• 批准号: 07670821
• 负责人: IWASAKA Toshiji
• 金额: $ 1.41万
• 依托单位: KANSAI MEDICAL UNIVERSITY
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1995
• 资助国家: 日本
• 起止时间: 1995 至 1997
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-07670821/
• 关键词: renin-angiotensin system; angiotensin-converting enzyme; gene polymorphism; myocardiaol infarction; left ventricular remodeling; mortality; ACE遺伝子多型

Angiotensin-converting enzyme (ACE) gene insertion / deletion (I/D) polymorphism has been demonstrated to be associated with serum and cardiac ACE activity. To evaluate the association of the ACE gene I/D polymorphism with left ventricular remodeling and in-hospital mortality, we studied 290 consecutive patients with a first myocardial infarction who were admitted to our cardiovascular center.There were 82 patients who received echocardiography 2 weeks and 1 year after onset of myocardial infaction. Left ventricular remodeling was defined as the increase in left ventricular end-diastolic volume index * 20% at the recording of echocardiogram 1 year after onset compared to that of 2 weeks after onset. There were 11 patients with the DD genotype, 38 patients with the ID genotype, and 33 patients with the II genotype. Left ventricular remodeling was found in 4 patients (36%) of the DD genotype, 9 patients (24%) of the ID genotype, and 6 patients (18%) of the II genotype. Biological gradien … More t was observed among these 3 groups, but did not reach statistical significance (p=0.1591). Logistic regression analysis was used to evaluate the association of the ACE gene genotype (DD v.s.ID/II) with left ventricular remodeling. After adjustment for age, site of myocardial infarction, reperfusion therapy during acute phase, ACE inhibitor use, history of hypertension, and ejection fraction 2 weeks after onset, the DD genotype had a tendency to be associated with left ventricular remodeling (odds ratio=2.486, p=0.1722). Our sample size might be too small to detect a 15% difference in the incidence of left ventricular remodeling between the DD and the ID/II genotypes.On the other hand, in-hospital mortality was compared between the DD genotype and the ID/II genotypes in 290 consecutive patients using the logistic regression analysis adjusted for age, sex, site of myocardial infarction, Killip functional class, reperfusion therapy during acute phase, ACE inhibitor use, and beta-blocker use. There were 45 patients with the DD genotype, 128 patients with the ID genotype, and 117 patients with the II genotype. Twenty-eight patients died during hospitalization (1 with the DD,18 with the ID,and 9 with the II genotype). The DD genotype was significantly associated with lower in-hospital mortality (p=0.0227) after adjustment for the clinical variables. Our results clinically supported preconditioning effect of angiotensin II observed in experimental studies. Less

血管紧张素转换酶（ACE）基因插入/缺失（I/D）多态性已被证明与血清和心脏ACE活性相关。为了评价ACE基因I/D多态性与左心室重构和住院死亡率的关系，我们研究了290例首次心肌梗死的患者，其中82例患者在心肌梗死发生后2周和1年接受了超声心动图检查。左心室重构定义为与发病后2周相比，发病后1年超声心动图记录的左心室舒张末期容积指数增加 * 20%。有11例患者为DD基因型，38例患者为ID基因型，33例患者为II基因型。DD基因型4例（36%）、ID基因型9例（24%）、II基因型6例（18%）出现左室重构。生物梯度 ...更多信息 在这3组中观察到t，但未达到统计学显著性（p=0.1591）。采用Logistic回归分析评价ACE基因型（DD vs. ID/II）与左室重构的关系。在校正年龄、心肌梗死部位、急性期再灌注治疗、ACE抑制剂使用、高血压病史和发病后2周射血分数后，DD基因型倾向于与左心室重构相关（比值比=2.486，p=0.1722）。我们的样本量可能太小，无法检测到DD和ID/II基因型之间左心室重构发生率的15%差异。另一方面，在290例连续患者中，使用logistic回归分析比较DD基因型和ID/II基因型之间的住院死亡率，该分析调整了年龄、性别、心肌梗死部位、Killip功能分级、急性期再灌注治疗、ACE抑制剂使用和β受体阻滞剂使用。其中DD型45例，ID型128例，II型117例。28例患者在住院期间死亡（1例DD，18例ID，9例II基因型）。在调整临床变量后，DD基因型与较低的住院死亡率显著相关（p=0.0227）。我们的研究结果在临床上支持血管紧张素II的预适应作用在实验研究中观察到。少