摘要
目的通过对原发性高血压(EH)病人血管紧张素转换酶(ACE)基因分型，探讨不同基因型的高血压病人对血管紧张素转换酶抑制剂(ACEI)治疗的反应性，以期指导临床合理用药。
方法随机选择健康志愿者99人，原发性高血压病人80人，用聚合酶链反应(PCR)方法检测ACE基因多态性，ACE基因有3种表现型：II型、DD型、ID型。将高血压病人分为II组(22例)，ID组(28例)，DD组(30例)，共80例。用ACEI对80例病人进行为期4周的降压治疗，所用药物为卡托普利。治疗前后对病人进行24小时动态血压监测(ABPM)，观察降压疗效。
结果在正常对照组中，ACE基因型为II型者23例(23％)，ID型者46例(47％)，DD型者30例(31％)。在高血压(EH)组中，II型者22例(28％)，ID型者28例(35％)，DD型者30例(37％)。ACE I／D各基因型在高血压组和正常对照组之间无显著差异(P＞0.05)。高血压组病人服用4周卡托普利后，II组有效16例，有效率73％；ID组有效22例，有效率79％；DD组有效25例，有效率83％。有效组与无效组ACE基因I／D基因型也无显著差异(P＞0.05)。
结论本研究结果表明，正常人与原发性高血压病人的血管紧张素转换酶基因型频率及等位基因频率无显著差异，说明血管紧张素转换酶基因的插入与缺失多态性与原发性高血压的发病无关。对卡托普利有效和无效的病人基因型频率及等位基因频率无显著差异，表明血管紧张素转换酶基因的插入与缺失多态性与血管紧张素转换酶抑制剂(卡托普利)的降压作用无关。
Purpose According to different ACE genotype with essential hypertension patients, to investigate responses of patients with different ACE genotype to the treatment of angiotensin-converting enzyme inhibitor (ACEI) ,in order to direct clinic useing drug. Method The materials for the present study were obtained from 99 healthy volunteer and 80 hypertensive patients,ACE gene polymorphsim was examined by the polymerase chain reaction (PCR) method and the patients was classified as II, ID and DD genotype.According to ACE gene I/D polymorphsim 80 patients with hypertension were divided in II (n=22) ,ID (n=28) and DD (n=30) groups.All patients were treated with captopril for 4 weeks.24 hour ambulatory blood pressure monitory was evaluated before and after treatment.Results The frequency of the II genotype was 23% (23), the ID genotype was 47% (46) and the DD genotype was 31% (30) in controls. The frequency of the II genotype was 28% (22) , the ID genotype was 35% (28) and the DD genotype was35% (28) in hypertensive patients. These results suggest that there is no significant difference in the distribution of ACE genotypes between hypertensive patients and controls(P>0.05). Captopril was administered for 4 weeks to 80 essential hypertensives, Validity was 73% in II (n=16) , Validity was 79% in ID (n=22) , Validity was 83% in DD (n=25) . There is no significant difference in the distribution of ACE genotypes between effective group and no effective group ( P>0.05) .Conclusion These results suggest that there is no significant difference in the distribution of ACE genotypes between hypertensive patients and controls, essential hypertension was not associated with ACE gene I/D polymorphsim. No significant association between the ACE gene I/D polymorphsim and the response of BP reduction by ACEI was found. These results suggest that ACE gene I/D polymorphsim do not associate to the blood pressure lowing response to antihypertensive treatment with ACE inhibition (captopril) .
引文
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