摘要： 目的 探讨急性缺血性卒中患者载脂蛋白E（ApoE）ε4 等位基因与血脂水平及预后的关系。方法 据ApoE 基因分型和美国国立卫生研究院卒中量表（NIHSS）评分，将786 例急性缺血性卒中患者分为携带ApoEε4 等位基因组和不携带ApoEε4 等位基因组，以及预后良好组（NIHSS 评分≤10 分）和预后不良组（NIHSS 评分> 10 分），分别采用单因素和前进法多因素Logistic 回归分析筛查影响携带ApoEε4 等位基因急性缺血性卒中患者预后的不良因素。结果 携带ApoEε4 等位基因组患者血清低密度脂蛋白胆固醇和载脂蛋白B 表达水平高于不携带ApoEε4 等位基因组［（3.25 ± 0.85）mmol/L 对（3.00 ±0.83）mmol/L，P = 0.008；（1.20 ± 0.30）mmol/L 对（1.09 ± 0.25）mmol/L，P = 0.000］。前进法多因素Logistic回归分析仅入院时NIHSS 评分和出院时改良Rankin 量表评分是影响急性缺血性卒中患者预后的主要危险因素（均P = 0.000），而ApoEε4 等位基因并非其影响因素（P = 0.343）。结论 携带ApoEε4 等位基因的急性缺血性卒中患者血清低密度脂蛋白胆固醇和载脂蛋白B 表达水平升高，但ApoEε4 等位基因并非预后不良的预测指标。

关键词: 脑缺血, 载脂蛋白E 类, 等位基因, 预后, 危险因素, 回归分析

Abstract: Objective  To explore the relationship between apolipoprotein E ε4 (ApoEε4) allele and blood lipid, and the relationship between ApoE ε 4 allele and the prognosis of acute ischemic stroke.  Methods  The study included 786 patients with acute ischemic stroke admitted in Tianjin Huanhu Hospital from December 1, 2013 to June 30, 2014. The ApoE genotype was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), ApoA, ApoB levels were also measured. The relationship between ApoE ε 4 allele and blood lipid was analyzed. All patients were assessed by National Institute of Health Stroke Scale (NIHSS) on discharge, and they were divided into 2 groups according to NIHSS score: favorable prognosis group (NIHSS ≤ 10) and unfavorable prognosis group (NIHSS > 10). The relationship between ApoE ε 4 allele and the outcome was analyzed by univariate and forward multivariate Logistic regression analysis.  Results  The ApoEε 4 allele carriers had significantly higher LDL-C and ApoB levels than the non-ApoEε4 allele carriers [(3.25 ± 0.85) mmol/L vs (3.00 ± 0.83) mmol/L, P = 0.008; (1.20 ± 0.30) mmol/L vs (1.09 ± 0.25) mmol/L, P = 0.000]. Forward multivariate Logistic regression analysis showed NIHSS score on admission and modified Rankin Scale (mRS) on discharge were the major influencing factors for prognosis of acute ischemic stroke (P = 0.000, for all). The ApoE ε 4 had no significant outstanding influence on the outcome of acute ischemic stroke (P = 0.343).  Conclusions  The presence of ApoE ε 4 allele do not predict a worse outcome of acute ischemic stroke, but it is associated with increased LDL-C and ApoB in acute ischemic stroke.

Key words: Brain ischemia, Apolipoproteins E, Alleles, Prognosis, Risk factors, Regression analysis