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目的评价血管紧张素Ⅱ1型受体(AngiotensinⅡtype 1 receptor,AT1R)基因1166位点A/C基因多态性对心力衰竭预后的影响。方法432例患者来源于美国匹兹堡大学医疗中心的心血管事件基因危险性评价研究组,均有收缩功能障碍性心力衰竭〔射血分数(EF)<0.45〕。入选时间为1996年4月至2001年1月,前瞻性随访患者(26.43±18.19)月,随访终点是死亡或心脏移植。用聚合酶链式反应(PCR)方法鉴定AT1R基因A1166C位点基因型,分析AT1R A1166C基因多态性对心力衰竭患者生存率的影响。结果AT1R纯合子CC型8.6%,纯合子AA型50.0%,杂合子AC型41.4%。三组基因型在年龄、性别、种族、病因、血压和治疗方面无显著性差异,而在NYHA心功能分级的比例有显著性差异,AT1R C等位基因与较低心功能分级密切相关(P=0.04),但随访三组基因型的三年生存率并无显著性差异。结论在本组收缩功能障碍性心力衰竭患者中,AT1R C等位基因仅与较低心功能分级密切相关,并不影响未行心脏移植心力衰竭患者的预后。
Objective To evaluate the effect of A / C polymorphism at the 1166 site of angiotensin Ⅱ type 1 receptor (AT1R) gene on the prognosis of heart failure. Methods 432 cases of patients from the University of Pittsburgh Medical Center of cardiovascular events gene risk assessment study group, both systolic dysfunction heart failure (ejection fraction (EF) <0.45〕. The enrollment time ranged from April 1996 to January 2001 and was followed up prospectively (26.43 ± 18.19) months. The end of follow-up was death or heart transplantation. The A1166C locus of AT1R gene was identified by polymerase chain reaction (PCR) and the effect of AT1R A1166C gene polymorphism on the survival rate of patients with heart failure was analyzed. RESULTS: The AT1R homozygote CC was 8.6%, the homozygous AA was 50.0%, and the heterozygous AC was 41.4%. There was no significant difference in age, gender, race, etiology, blood pressure and treatment among the three genotypes, but there was a significant difference in NYHA functional class. The AT1R C allele was associated with lower cardiac function classification (P = 0.04), but there was no significant difference in three-year survival rate between the three genotypes at follow-up. Conclusions Among the patients with systolic dysfunction and heart failure, the AT1R C allele is only closely related to the lower grade of cardiac function, and does not affect the prognosis of heart failure patients without heart transplantation.