Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China; Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China.
Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China.
J Stroke Cerebrovasc Dis. 2021 Mar;30(3):105579. doi: 10.1016/j.jstrokecerebrovasdis.2020.105579. Epub 2021 Jan 4.
Cerebral small vessel disease (CSVD) causes a quarter of all strokes and is the most common pathology underlying vascular dementia. However, the mechanism of CSVD remains unclear. Numerous studies have investigated whether the angiotensin-converting enzyme (ACE) intersection/deletion (I/D) polymorphism influences the risk of CSVD, but the results are controversial.
We searched English and Chinese databases and calculated the odds ratio (OR) and 95% confidence interval (CI) to examine the existence of genetic associations between the ACE I/D polymorphism and the risk of CSVD. All relevant studies were screened and meta-analyzed using Review Manager 5.4.
A total of 27 studies involving 7,186 subjects were identified for the meta-analysis. The results of five genetic models showed a significantly increased risk of CSVD (allelic, OR=1.30; recessive, OR=1.41; dominant, OR=1.34; homozygous, OR=1.55 and heterozygous OR=1.22) in the overall analysis. Furthermore, in subgroup analysis, increased CSVD risks were also observed in Asian and Caucasian populations. We also found no relationship between ACE I/D and leukoaraiosis (LA) in patients with lacunar infarction (LI).
The ACE I/D polymorphism was positively associated with CSVD in both populations. However, this polymorphism did not increase the risk of LA in LI patients.
脑小血管病（CSVD）导致四分之一的中风，是血管性痴呆的最常见病理基础。然而，CSVD 的发病机制仍不清楚。许多研究调查了血管紧张素转换酶（ACE）插入/缺失（I/D）多态性是否影响 CSVD 的风险，但结果存在争议。
我们检索了英文和中文数据库，并计算了比值比（OR）和 95%置信区间（CI），以检验 ACE I/D 多态性与 CSVD 风险之间是否存在遗传关联。使用 Review Manager 5.4 筛选并荟萃分析所有相关研究。
共纳入 27 项研究，涉及 7186 名受试者进行荟萃分析。五种遗传模型的结果表明，总体分析中 CSVD 的风险显著增加（等位基因，OR=1.30；隐性，OR=1.41；显性，OR=1.34；纯合子，OR=1.55；杂合子 OR=1.22）。此外，亚组分析显示，在亚洲人和高加索人群中也观察到 CSVD 风险增加。我们还发现 ACE I/D 与腔隙性梗死（LI）患者的脑白质疏松症（LA）之间没有关系。
ACE I/D 多态性与两种人群中的 CSVD 呈正相关。然而，这种多态性不会增加 LI 患者 LA 的风险。
