Malueka Rusdy Ghazali, Dwianingsih Ery Kus, Sutarni Sri, Bawono Rheza Gandi, Bayuangga Halwan Fuad, Gofir Abdul, Setyopranoto Ismail
a Neurology Department, Medical Faculty , Universitas Gadjah Mada , Yogyakarta , Indonesia.
b Department of Anatomical Pathology, Faculty of Medicine , Universitas Gadjah Mada , Yogyakarta , Indonesia.
Int J Neurosci. 2018 Aug;128(8):697-704. doi: 10.1080/00207454.2017.1412962. Epub 2017 Dec 29.
Insertion/deletion polymorphism in ACE gene (ACE I/D) is known to be associated with the occurrence of ischaemic stroke through its effect on pathogenesis of atherosclerosis and hypertension. This study was aimed to examine the association between this polymorphism with functional outcome of ischaemic stroke.
This was a cross-sectional study. The subjects were patients with ischaemic stroke in a reference hospital in Yogyakarta, Indonesia. Data on demographic characteristics, stroke risk factors, comorbidities and stroke severity were assessed on admission. The functional outcome, Barthel index (BI), was assessed when the patients were discharged from the hospital. ACE I/D genotypes of the patients were identified by polymerase chain reaction (PCR).
In total, 61 patients were included. Of these, 38 patients (62.3%) had II polymorphism, 22 patients (36.1%) had ID polymorphism and 1 patient (1.6%) had DD polymorphism in the ACE gene. There were significant differences in the functional outcomes between patients without D allele (II polymorphisms) and patients with D allele (ID and DD polymorphism) (mean BI on discharge: 75 ± 23.57 and 60.65 ± 27.15, respectively; p = 0.034). Multiple linear regression model showed that the availability of D allele is an independent variable negatively associated with functional outcome as assessed by BI (β = -0.232, p = 0.024).
This study showed that the D allele in ACE I/D polymorphism is associated with worse functional outcomes. This highlights the possibility of further research to improve functional outcomes of ischaemic stroke by inhibiting the ACE system.
已知血管紧张素转换酶基因插入/缺失多态性（ACE I/D）通过其对动脉粥样硬化和高血压发病机制的影响与缺血性中风的发生相关。本研究旨在探讨这种多态性与缺血性中风功能结局之间的关联。
这是一项横断面研究。研究对象为印度尼西亚日惹一家参考医院的缺血性中风患者。入院时评估患者的人口统计学特征、中风危险因素、合并症和中风严重程度。患者出院时评估其功能结局，即巴氏指数（BI）。通过聚合酶链反应（PCR）鉴定患者的ACE I/D基因型。
总共纳入61例患者。其中，38例患者（62.3%）具有II多态性，22例患者（36.1%）具有ID多态性，1例患者（1.6%）具有DD多态性。无D等位基因的患者（II多态性）与有D等位基因的患者（ID和DD多态性）之间的功能结局存在显著差异（出院时平均BI分别为：75±23.57和60.65±27.15；p = 0.034）。多元线性回归模型显示，D等位基因的存在是与BI评估的功能结局呈负相关的独立变量（β = -0.232，p = 0.024）。
本研究表明，ACE I/D多态性中的D等位基因与较差的功能结局相关。这凸显了通过抑制ACE系统进一步研究改善缺血性中风功能结局的可能性。
