摘要
目的 探讨载脂蛋白E(ApoE)基因单核苷酸多态性(SNP)与老年原发性高血压(PH)并发心房颤动(房颤)的关系.方法 前瞻性观察性研究.连续纳入 2020 年8 月至2023 年8 月贵州医科大学附属医院收治的 678 例老年PH患者为研究对象,根据患者房颤发生情况,分为房颤组(256 例)与非房颤组(422 例).收集患者临床资料,比较两组间差异.通过MassARRAY 平台检测患者ApoE基因SNP,分析两组ApoE基因SNP位点的基因型和等位基因分布情况.采用多因素logistic回归分析ApoE基因SNP位点与老年PH并发房颤的关系.结果 房颤组年龄、吸烟史占比、24 h平均收缩压、高血压病程、三酰甘油、低密度脂蛋白胆固醇(LDL-C)、左心房内径(LAD)和左心室舒张末期内径(LVEDD)均大于非房颤组(均为P<0.05),左心室射血分数(LVEF)小于非房颤组(P<0.001).房颤组ApoE基因rs440446 位点A等位基因频率以及rs439401 位点AA基因型频率和A等位基因频率高于非房颤组(均为P<0.05);房颤组ApoE基因rs405509 位点GG基因型频率和G等位基因频率低于非房颤组(均为P<0.05).多因素logistic回归分析结果显示,年龄、24 h平均收缩压、高血压病程、LDL-C、LAD、LVEDD以及ApoE基因rs440446 位点A等位基因、rs439401 位点AA基因型与A等位基因均是老年PH并发房颤的危险因素(均为P<0.05),ApoE基因rs405509 位点G等位基因是其保护因素(P=0.046).进一步校正混杂因素(年龄、24 h 平均收缩压、高血压病程、LDL-C、LAD、LVEDD)后,多因素logistic回归分析显示,ApoE基因rs440446 位点A等位基因、rs439401 位点AA基因型与A等位基因、rs405509 位点G等位基因仍是老年PH并发房颤的影响因素(均为P<0.05).结论 ApoE基因rs440446、rs439401、rs405509 位点多态性与老年PH患者并发房颤存在关联,对老年PH患者防治房颤具有一定的指导意义.
Abstract
Objective To investigate the relationship between apolipoprotein E(ApoE)single nucleotide polymorphism(SNP)and atrial fibrillation in elderly patients with primary hypertension(PH).Methods This was a prospective observational study.The 678 elderly patients with PH admitted to the Affiliated Hospital of Guizhou Medical University from August 2020 to August 2023 were continuously included as the study subjects,and the patients were divided into atrial fibrillation group(256 cases)and non atrial fibrillation group(422 cases)based on the incidence of atrial fibrillation.Clinical data of patients were collected and compared between the two groups.The ApoE gene SNP was detected by using MassARRAY SNP typing technology,and the genotype and allele distribution of SNP loci of the ApoE gene between the two groups were analyzed.The relationship between ApoE gene SNP loci and atrial fibrillation was analyzed by using logistic regression analysis.Results In the atrial fibrillation group,age,proportion of smoking history,24 h mean systolic blood pressure,duration of hypertension,triglycerides,low-density lipoprotein cholesterol(LDL-C),left atrial diameter(LAD)and left ventricular end-diastolic diameter(LVEDD)were significantly higher compared to those in non atrial fibrillation group(all P<0.05),while left ventricular ejection fraction(LVEF)was lower(P<0.001).The frequency of genotype A allele at rs440446 locus and the frequency of AA genotype and A allele at rs439401 locus of the ApoE gene in the atrial fibrillation group were higher than those in non atrial fibrillation group(all P<0.05).The GG genotype frequency and G allele frequency at the rs405509 locus of the ApoE gene in atrial fibrillation group were lower than those in non atrial fibrillation group(both P<0.05).The results of multivariate logistic regression analysis showed that age,24 h mean systolic blood pressure,hypertension course,LDL-C,LAD,LVEDD and allele A at rs440446 locus,genotype AA and allele A at rs439401 locus of the ApoE gene were all risk factors for elderly PH complicated with atrial fibrillation(all P<0.05),while allele G at rs405509 locus of the ApoE gene was a protective factor(P=0.046).After adjusting for confounding factors(age,24-h mean systolic blood pressure,hypertension course,LDL-C,LAD and LVEDD),multivariate logistic regression analysis showed that allele A at rs440446 locus,genotype AA and allele A at rs439401 locus,as well as allele G at rs405509 locus of the ApoE gene were still influencing factors for elderly PH complicated with atrial fibrillation(all P<0.05).Conclusions The polymorphism of the rs440446,rs439401 and rs405509 loci in the ApoE gene are associated with the occurrence of atrial fibrillation in elderly PH patients,which has a certain guiding significance for the prevention and treatment of atrial fibrillation in elderly PH patients.
基金项目
贵州省科技合作计划项目(黔科合LH字[2015]7426号)
NETL
NSTL
万方数据