【摘要】 目的 通过检测冠心病介入治疗患者载脂蛋白E(ApoE)基因型，进而探讨其与血脂相关性、他汀类药物对不同Apo E基因分型患者血脂调控及预后的影响。方法 选取石景山医院2018年1月至2019年5月收治的行冠心病介入治疗的患者共165例，采用PCR荧光探针法检测ApoE基因型，将检测出的基因型分为三组：E2基因型组（E2/2+E2/3）19例、E3基因型组（E3/3）122例、E4基因型组（E4/3+E4/4）24例，分别测定患者服用他汀类药物治疗前及治疗1年后的血脂水平，分析基因型与调脂疗效的关系。结果 冠心病介入治疗患者共检出E2、E3、E4三种等位基因，E2/E2、E2/3、E3/3、E4/3、E4/4五种基因型，以E3/3占比最高（73.94%）,E4/4(1.82%)、E2/2(0.61%)占比较低，未检测出E2/4。不同基因组其血脂水平存在一定差异，E4基因型组低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TG）高于E3基因型组（P <0.05），高密度脂蛋白胆固醇（HDL-C）低于E2基因型组（P <0.05），载脂蛋白B(ApoB)高于E2基因型组（P <0.05）。他汀类药物治疗1年后，三组总胆固醇（TC）、LDL-C、HDL-C、TG水平均较治疗前改善（P <0.05）。E4基因型组1年内再次血运重建事件发生率高于E2、E3基因型组（P <0.05）。结论 ApoE4等位基因可能增加冠心病介入治疗人群再发心血管事件的风险，对他汀治疗的疗效欠佳，对此基因型患者可调整他汀用药方案（加大剂量或者更换类型），以期达到更佳临床治疗效果。更多还原

【Abstract】 Objective To investigate the relationship between apolipoprotein E(ApoE) genotype and blood lipids by detecting ApoE genotype in patients undergoing interventional therapy for coronary heart disease, and explore the effect of statins on blood lipid regulation and prognosis in patients with different ApoE genotypes.Methods A total of 165 patients undergoing interventional therapy for coronary heart disease in Beijing Shijingshan Hospital from January 2018 to May 2019 were selected. ApoE genotypes were detected by PCR fluorescent probe method. The detected genotypes were divided into three groups: 19 cases of E2 genome group(E2/2+E2/3), 122 cases of E3 genome group(E3/3) and 24 cases of E4 genome group(E4/3+E4/4). The blood lipid levels of patients before and after one-year treatment with statins were measured respectively, and the relationship between genotype and lipid-regulating effect was analyzed. Results Among those patients undergoing interventional therapy for coronary heart disease, three alleles of E2, E3 and E4 and five genotypes of E2/E2, E2/3, E3/3, E4/3 and E4/4 were detected. The proportion of E3/3 was the highest(73.94%), the proportions of E4/4(1.82%) and E2/2(0.61%) were relatively low, and E2/4 was not detected. There was certain difference in the blood lipid level among patients with different genomes. The levels of low-density lipoprotein cholesterol(LDL-C) and triglycerides(TG) in the E4 genome group were higher than those in the E3 genome group(P < 0.05), the high-density lipoprotein cholesterol(HDL-C) level was lower than that in the E2 genome group(P < 0.05), and the apolipoprotein B(ApoB) level was higher than that in the E2 genome group(P < 0.05).After 1 year of statin treatment, the total cholesterol(TC), LDL-C, HDL-C and TG levels in the three groups improved compared with those before treatment(P < 0.05). The incidence of revascularization events within one year in the E4 genome group was higher than that in the E2 and E3 genome groups(P < 0.05). Conclusion ApoE4 allele may increase the risk of recurrent cardiovascular events in population undergoing interventional therapy for coronary heart disease. For patients with this genotype, the effect of statin treatment is not good,and the statin treatment regime may be adjusted(to increase the dose or change the drug type) to achieve better clinical treatment effect.更多还原