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

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。为了评估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例连续入住心血管中心的首次心肌梗死患者。82例患者在心肌梗死发病2周和1年后接受超声心动图检查。左室重构定义为发病后1年超声心动图记录时左室舒张末期容积指数比发病后2周增加20%。DD基因型11例，ID基因型38例，II基因型33例。DD基因型4例（36%）、ID基因型9例（24%）、II基因型6例（18%）出现左心室重构。3组间差异有统计学意义（p=0.1591），但差异无统计学意义（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。在调整年龄、心肌梗死部位、急性期再灌注治疗、ACE抑制剂使用、高血压史、发病后2周射血分数等因素后，DD基因型倾向于与左心室重构相关（优势比=2.486,p=0.1722）。我们的样本量可能太小，无法检测到DD和ID/II基因型左心室重构发生率的15%差异。另一方面，对290例连续患者的DD基因型和ID/II基因型的住院死亡率进行了logistic回归分析，校正了年龄、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受体阻滞剂使用等因素。DD基因型45例，ID基因型128例，II基因型117例。28例患者在住院期间死亡（DD 1例，ID 18例，II基因型9例）。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）。我们的研究结果支持了实验中观察到的血管紧张素II的预处理作用。少

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