ApoE基因多态性与缺血性卒中的相关性研究-东南大学学报医学版

ApoE基因多态性与缺血性卒中的相关性研究

单位：1. 东南大学医学院/东南大学附属中大医院神经内科, 江苏南京 210009;
2. 东南大学附属中大医院临床检验中心, 江苏南京 210009

分类号：R743.3

出版年·卷·期（页码）：2019·38·第六期（941-946）

摘要：

目的：探讨ApoE基因多态性与缺血性卒中发病的严重程度及预后的相关性。方法：根据ApoE 等位基因分型将缺血性卒中患者分为ApoE ε 2、ApoE ε 3和ApoE ε 4共3组，比较各组间血脂水平、入院时美国国立卫生院神经功能缺损（NIHSS）评分以及出院时改良RANKIN量表（mRS）评分，研究ApoE不同等位基因与缺血性卒中的发病严重程度及预后的相关性。结果：（1）ApoE ε 2组的高密度脂蛋白水平明显高于ApoE ε 3组（P < 0.05）。（2）ApoE ε 4组NIHSS评分明显高于ApoE ε 3组及ApoE ε 2组（P < 0.05）。（3）ApoE ε 4等位基因与急性缺血性卒中预后不良无明显相关（P=0.869）。结论：缺血性卒中患者携带ApoE ε 2等位基因是其保护性因素，而携带ApoE ε 4等位基因可能与缺血性卒中发病的严重程度有一定的相关性。

Objective: To investigate the relationship between the apolipoprotein E (ApoE) gene polymorphism and the severity,prognosis of acute ischemic stroke caused by atherosclerosis. Methods: According to the ApoE allele genotyping, patients with ischemic stroke were divided into 3 groups:ApoE ε 2, ApoE ε 3, and ApoE ε 4 group. Then, the level of lipids, NIHSS scores at admission and mRS scores at discharge were analyzed and compared among each group. Eventually, the relationship between ApoE alleles and the severity,prognosis of ischemic stroke were analyzed. Results: (1) The level of high-density lipoprotein in ApoE ε 2 group were significantly higher than that in ApoE ε 3 group (P < 0.05).(2) The NIHSS scores of the ApoE ε 4 group were significantly higher than that in ApoE ε 3group or ApoE ε 2 group(P < 0.05).(3)Patients carrying ApoE ε 4 allele was not closely related to poor prognosis (P=0.869). Conclusions:ApoE ε 2 allele is a protective factor to ischemic stroke patients. Whereas ApoE ε 4 allele may correlate with the severity of ischemic stroke.

参考文献：

[1] WANG W,JIANG B,SUN H,et al.Prevalence,incidence,and mortality of stroke in china:results from a nationwide population-based survey of 480687 adults[J].Circulation,2017,135(8):759-771.
[2] WANG Y,ZHAO X,LIU L,et al.Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China:The Chinese Intracranial Atherosclerosis (CICAS) Study[J].Stroke,2014,45(3):663-669.
[3] BALOCH Z W,HARRELL R M,BRETT E M,et al.American association of clinical endocrinologists and american college of endocrinology disease state commentary:Managing thyroid tumors diagnosed as noninvasive follicular thyroid neoplasm with papillary-like nuclear features[J].Endocr Pract,2017,23(9):1150-1155.
[4] 冯燕娴,石增刚,汤凤英,等.血清载脂蛋白B、载脂蛋白B/载脂蛋白A1值与冠状动脉病变的相关性分析[J].东南大学学报(医学版),2011,30(4):577-580.
[5] HAUSER P S,NARAYANASWAMI V,RYAN R O.Apolipoprotein E:From lipid transport to neurobiology[J].Prog Lipid Res,2011,50(1):62-74.
[6] GU L,SU L,CHEN Q,et al.Association between the apolipoprotein E gene polymorphism and ischemic stroke in Chinese populations:New data and meta-analysis[J].Exp Ther Med,2013,5(3):853-859.
[7] 中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[8] JR A H,BENDIXEN B H,KAPPELLE L J,et al.Classification of subtype of acute ischemic stroke.Definitions for use in a multicenter clinical trial.TOAST.Trial of Org 10172 in Acute Stroke Treatment[J].Stroke,1993,24(1):35-41.
[9] WENHAM P R,PRICE W H,BLANDELL G.Apolipoprotein E typing by one-stage PCR[J].Lancet,1991,337(8750):1158-1159.
[10] MAHLEY R W,RALL S J.Apolipoprotein E:Far more than a lipid transport protein[J].Annu Rev Genomics Hum Genet,2000,1:507-537.
[11] BALLARD C G,MORRIS C M,RAO H,et al.APOE epsilon 4 and cognitive decline in older stroke patients with early cognitive impairment[J].Neurology,2004,63(8):1399.
[12] BEISIEGEL U,WEBER W,IHRKE G,et al.The LDL receptor related protein,LRP,is an apolipoprotein E-binding protein[J].Nature,1989,341(6238):162-164.
[13] BIFFI A,ANDERSON C D,JAGIELLA J M,et al.APOE genotype predicts extent of bleeding and outcome in lobar intracerebral hemorrhage[J].Lancet Neurol,2011,10(8):702.
[14] MARTÍNEZGONZLEZ N A,SUDLOW C L M.Effects of apolipoprotein E genotype on outcome after ischaemic stroke,intracerebral haemorrhage and subarachnoid haemorrhage[J].J Neuro Neurosur Psy,2006,77(12):1329-1335.
[15] 刘岩峰,黄平,何欣,等.ApoE的研究进展及其在脑外伤发生中的意义[J].证据科学,2007,14(1):72-75.
[16] 张斌,陈伟,张嵘,等.中国人载脂蛋白e基因多态性与轻度认知功能损害关系的meta分析[J].东南大学学报(医学版),2015,34(1):83-87.
[17] MCCARRON M O,DELONG D,ALBERTS M J.APOE genotype as a risk factor for ischemic cerebrovascular disease:A meta-analysis[J].Neurology,1999,53(6):1308-1311.
[18] HORSBURGH K,KELLY S,MCCULLOCH J,et al.Increased neuronal damage in apolipoprotein E-deficient mice following global ischaemia[J].Neuroreport,1999,10(4):837-841.
[19] SHENG H,LASKOWITZ D T,MACKENSEN G B,et al.Apolipoprotein E deficiency worsens outcome from global cerebral ischemia in the mouse[J].Stroke,1999,30(5):1118-1124.
[20] MCCOLL B W,MCGREGOR A L,WONG A,et al.APOE epsilon 3 gene transfer attenuates brain damage after experimental stroke[J].J Cereb Blood Flow Metab,2007,27(3):477-487.
[21] GUO L,LADU M J,VAN ELDIK L J.A dual role for apolipoprotein e in neuroinflammation:Anti-and pro-inflammatory activity[J].J Mol Neurosci,2004,23(3):205-212.
[22] ALPÉROVITCH A,KURTH T,BERTRAND M,et al.Primary prevention with lipid lowering drugs and long term risk of vascular events in older people:Population based cohort study[J].BMJ,2015,350:h2335.
[23] FULCHER J,O'CONNELL R,VOYSEY M,et al.Efficacy and safety of LDL-lowering therapy among men and women:Meta-analysis of individual data from 174,000 participants in 27 randomised trials[J].Lancet,2015,385(9976):1397-1405.
[24] 诸骏仁,高润霖,赵水平,等.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,16(10):15-35.
[25] VITALI C,KHETARPAL S A,RADER D J.HDL cholesterol metabolism and the risk of CHD:New insights from human genetics[J].Curr Cardiol Rep,2017,19(12):132.
[26] MIYATA M,SMITH J D.Apolipoprotein E allele-specific antioxidant activity and effects on cytotoxicity by oxidative insults and β-amyloid peptides-Nature Genetics[J].Nat Genet,1996:51-62.
[27] CATTO A J,MCCORMACK L J,MANSFIELD M W,et al.Apolipoprotein E polymorphism in cerebrovascular disease[J].Acta Neurol Scand,2000,101(6):399.
[28] GROMADZKA G,BARANSKA GIERUSZCZAK M,SARZYNSKA DLUGOSZ I,et al.The APOE polymorphism and 1-year outcome in ischemic stroke:genotype-gender interaction[J].Acta Neurol Scand,2007,116(6):392-398.
[29] WEIR C J,MCCARRON M O,MUIR K W,et al.Apolipoprotein E genotype,coagulation,and survival following acute stroke[J].Neurology,2001,57(6):1097-1100.
[30] TREGER I,FROOM P,RING H,et al.Association between apolipoprotein E4 and rehabilitation outcome in hospitalized ischemic stroke patients[J].Arch Phys Med Rehab,2003,84(7):973-976.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录