Okamura A, Ohishi M, Rakugi H, Katsuya T, Yanagitani Y, Takiuchi S, Taniyama Y, Moriguchi K, Ito H, Higashino Y, Fujii K, Higaki J, Ogihara T
Department of Geriatric Medicine, Osaka University Medical School, Suita, Japan.
Angiology. 1999 Oct;50(10):811-22. doi: 10.1177/000331979905001005.
Angiotensin-converting enzyme (ACE) inhibitors are reported to prevent neointimal formation after balloon injury in animal models, but in most prospective studies in humans, ACE inhibitors failed to prevent restenosis after percutaneous transluminal coronary angioplasty (PTCA). The ACE genotype assigned by an insertion/deletion (I/D) polymorphism is known to affect the potency of ACE inhibitors in several renal diseases. The authors attempted to clarify whether the effect of ACE inhibitors on restenosis might be modified by the ACE genotype. A total of 126 patients was randomly and prospectively assigned to the control group and the imidapril group. In the imidapril group, patients received 5 mg imidapril daily, starting 1 day before PTCA and continuing for 3 to 6 months. Forty-six control (65 vessels) and 32 imidapril patients (43 vessels) completed the study. The minimal lumen diameter before and after the procedure did not differ significantly among the groups with the three genotypes (II, ID, and DD) in both the control and imidapril groups. Late luminal loss during the follow-up period was not related to the ACE genotype in the control group but was significantly related in the imidapril group (II, 0.63+/- 0.19 mm; ID + DD, 1.12+/-0.14 mm, p<0.05). Furthermore, in the II genotype, imidapril significantly reduced late loss and restenosis rate as defined by most of the frequently used definitions. In conclusion the ACE I/D polymorphism may influence the effect of ACE inhibitors in preventing restenosis after PTCA.
据报道，在动物模型中，血管紧张素转换酶（ACE）抑制剂可预防球囊损伤后新生内膜的形成，但在大多数针对人类的前瞻性研究中，ACE抑制剂未能预防经皮腔内冠状动脉成形术（PTCA）后的再狭窄。已知由插入/缺失（I/D）多态性确定的ACE基因型会影响ACE抑制剂在几种肾脏疾病中的效力。作者试图阐明ACE抑制剂对再狭窄的影响是否可能因ACE基因型而改变。总共126例患者被随机且前瞻性地分为对照组和咪达普利组。在咪达普利组中，患者从PTCA前1天开始每天服用5mg咪达普利，并持续3至6个月。46名对照组患者（65条血管）和32名咪达普利组患者（43条血管）完成了研究。在对照组和咪达普利组中，具有三种基因型（II、ID和DD）的组之间，术前和术后的最小管腔直径没有显著差异。随访期间的晚期管腔丢失在对照组中与ACE基因型无关，但在咪达普利组中显著相关（II型，0.63±0.19mm；ID + DD型，1.12±0.14mm，p<0.05）。此外，在II基因型中，根据大多数常用定义，咪达普利显著降低了晚期丢失和再狭窄率。总之，ACE I/D多态性可能会影响ACE抑制剂预防PTCA后再狭窄的效果。
