Pfohl M, Athanasiadis A, Koch M, Clemens P, Benda N, Häring H U, Karsch K R
Department of Medicine, University of Tübingen, Germany.
J Am Coll Cardiol. 1998 Apr;31(5):987-91. doi: 10.1016/s0735-1097(98)00044-8.
We evaluated the influence of the insertion/deletion (I/D) polymorphism of the angiotensin I-converting enzyme (ACE) gene on coronary plaque morphology and calcification in patients with angiographically documented coronary artery disease (CAD).
The ACE I/D polymorphism has been associated with an increased risk of myocardial infarction in patients with the DD genotype but not with the presence of native CAD.
We studied 146 patients undergoing percutaneous transluminal coronary angioplasty for stable angina pectoris by means of preinterventional intravascular ultrasound (IVUS). Qualitative and quantitative criteria were used to classify the target lesions as poorly or highly echoreflective or as calcified. Genomic deoxyribonucleic acid was analyzed by polymerase chain reaction (PCR) to identify the I/D polymorphism, with a second insertion-specific PCR in DD genotypes to prevent mistyping.
The ACE genotype groups (DD 46, ID 68, II 32) were well matched for the basic characteristics. Patients with the DD genotype had significantly more calcified lesions (DD 80%, ID 57%, II 66%; unadjusted odds ratio [OR] 2.88, 95% confidence interval [CI] 1.30 to 6.92, p = 0.008) and more calcifications >180 degrees of the vessel circumference (DD 22%, ID 10%, II 6%; OR 2.80, 95% CI 1.05 to 7.63, p = 0.03). The prevalence of myocardial infarction was not significantly associated with coronary calcification (OR 1.44, 95% CI 0.72 to 2.88, p = 0.31).
Patients with CAD and the ACE DD genotype have a significantly higher incidence and greater extent of coronary lesion calcification, as determined by IVUS. This finding indicates that the ACE I/D gene polymorphism is related to the development or progression of atherosclerotic plaque calcification.
我们评估了血管紧张素I转换酶（ACE）基因插入/缺失（I/D）多态性对经血管造影证实患有冠状动脉疾病（CAD）患者冠状动脉斑块形态和钙化的影响。
ACE I/D多态性与DD基因型患者心肌梗死风险增加相关，但与天然CAD的存在无关。
我们通过介入前血管内超声（IVUS）研究了146例因稳定型心绞痛接受经皮腔内冠状动脉成形术的患者。使用定性和定量标准将目标病变分类为低回声或高回声或钙化。通过聚合酶链反应（PCR）分析基因组脱氧核糖核酸以鉴定I/D多态性，在DD基因型中进行第二次插入特异性PCR以防止误分型。
ACE基因型组（DD 46例，ID 68例，II 32例）的基本特征匹配良好。DD基因型患者有更多的钙化病变（DD 80%，ID 57%，II 66%；未调整优势比[OR] 2.88，95%置信区间[CI] 1.30至6.92，p = 0.008）以及更多超过血管圆周180度的钙化（DD 22%，ID 10%，II 6%；OR 2.80，95%CI 1.05至7.63，p = 0.03）。心肌梗死的患病率与冠状动脉钙化无显著相关性（OR 1.44，95%CI 0.72至2.88，p = 0.31）。
经IVUS测定，CAD患者和ACE DD基因型患者冠状动脉病变钙化的发生率显著更高且程度更大。这一发现表明ACE I/D基因多态性与动脉粥样硬化斑块钙化的发生或进展有关。
