Park H Y, Kwon H M, Kim D, Jang Y, Shim W H, Cho S Y, Kim H S
Department of Internal Medicine, Yonsei University, College of Medicine, Seoul, Korea.
J Korean Med Sci. 1997 Oct;12(5):391-7. doi: 10.3346/jkms.1997.12.5.391.
The deletion polymorphism of angiotensin converting enzyme (ACE) genotype has been reported as an independent risk factor for the development of myocardial infarction (MI). However there are conflicting data showing no relationship between the ACE genotype and coronary artery disease. The present study was performed to investigate the correlation between ACE genetic polymorphism and acute coronary syndrome by comparing the distribution of ACE genotypes and ACE activities in patients with acute MI and unstable angina with those in control group. The frequency of genotype DD was significantly higher in patients with acute coronary syndrome than in controls. Logistic regression analysis showed that ACE polymorphism affected the development of acute coronary syndrome in recessive pattern of D allele. When we divided the patients into MI and unstable angina groups, the frequencies of genotype DD and D allele were significantly higher in unstable angina group than in MI or control groups. In the patients with MI, the frequency of D allele was significantly higher in patients without previous angina than in those with previous angina. There was no significant difference in ACE genotype or allelic frequency according to the severity of coronary lesions. The ACE genotype was associated with marked differences of ACE activity, but there was no difference between the patient and control groups for each genotype. In conclusion, the genotype DD of ACE gene associated with acute coronary syndrome, but not with the severity of coronary artery lesion. These results showed that the genotype DD of ACE gene might be associated with acute coronary syndrome by another mechanism rather than the coronary atherosclerosis.
血管紧张素转换酶（ACE）基因的缺失多态性已被报道为心肌梗死（MI）发生的独立危险因素。然而，有相互矛盾的数据表明ACE基因与冠状动脉疾病之间没有关系。本研究旨在通过比较急性心肌梗死和不稳定型心绞痛患者与对照组的ACE基因型分布和ACE活性，探讨ACE基因多态性与急性冠状动脉综合征之间的相关性。急性冠状动脉综合征患者的DD基因型频率显著高于对照组。逻辑回归分析表明，ACE多态性以D等位基因的隐性模式影响急性冠状动脉综合征的发生。当我们将患者分为心肌梗死组和不稳定型心绞痛组时，不稳定型心绞痛组的DD基因型和D等位基因频率显著高于心肌梗死组或对照组。在心肌梗死患者中，无既往心绞痛患者的D等位基因频率显著高于有既往心绞痛患者。根据冠状动脉病变的严重程度，ACE基因型或等位基因频率没有显著差异。ACE基因型与ACE活性的显著差异有关，但每种基因型的患者组和对照组之间没有差异。总之，ACE基因的DD基因型与急性冠状动脉综合征有关，但与冠状动脉病变的严重程度无关。这些结果表明，ACE基因的DD基因型可能通过另一种机制而非冠状动脉粥样硬化与急性冠状动脉综合征相关。
