台灣地區年輕型高血壓族群AdiponectinT94G基因多型性與頑固性高血壓關係之探討

Association between Adiponectin T94G polymorphism and Resistant Hypertension in the Young-onset Hypertensives in Taiwan

卓士傑(Shih-Jie Jhuo)

指導教授 ： 林宗憲

高雄醫學大學/醫學院/醫學研究所碩士班/碩士(2015年)

摘要

研究背景與目的
年輕型高血壓患者相較於傳統高血壓患者具有較高的心血管疾病風險，需要積極的控制治療。頑固性高血壓的定義為使用超過三種以上的抗血壓藥物，其中必須包含一種利尿劑的使用。此類病人的心血管疾病風險也較一般病人為高。Adiponectin為主要的adipocytokine之一；根據目前研究顯示，adiponectin與血壓的高低具有相關性。而adiponectin gene的多型性對於血壓的影響，目前並無相關的研究證實。因此，本研究將對於年輕型高血壓患者adiponectin的基因多型性與頑固性高血壓是否具有相關性進行研究。
研究方法
我們收集自西元2002年2月到西元2006年10月罹患高血壓且年紀小於50歲的年輕型高血壓病人，分為具有頑固性高血壓及無頑固性高血壓的組別。在徵詢病人同意之後，抽血進行生化檢驗及基因多型性分析。利用SPSS第17版統計分析一些變數在兩組間的差異，包括個人特質及基本的生化數值分析、影響血壓的內分泌激素分析及基因多型性分析等。另外，我們也使用二項式回歸分析(binary regression analysis)來探討adiponectin基因多型性與年輕型頑固高血壓的關係。
結果
此研究中總共收錄861位年輕型高血壓病人中，共有54位病人具有頑固性高血壓。這些具有頑固性高血壓的病人相較於其他高血壓的病人有較高的腰圍、三酸甘油酯、血清尿素氮 (BUN)、肌酐酸、尿酸、aldosterone、C-reactive protein (CRP) 及纖維蛋白原 (fibrinogen)濃度。在adiponectin T94G基因多型性的分析中，帶G allele會有頑固性高血壓的族群的勝算比(odds ratio, OR)為2.45 (p=0.001)；同時G allele數與頑固性高血壓的表徵呈現線性關係 (p=0.01)。在二項式回歸分析中adiponectin T94G polymorphism (OR = 2.766, 95% CI = 1.434-5.338, p = 0.002)、年齡 (OR = 1.103, CI = 1.040-1.169, p = 0.001)、尿酸 (OR = 1.322, 95% CI = 1.126-1.552, p = 0.001)、CRP (OR = 2.769, 95% CI = 1.535-4.992, p = 0.001)及aldosterone (OR = 1.004, 95% CI = 1.002-1.006, p < 0.001)皆為影響有無頑固性高血壓表徵的獨立因子。
結論
Adiponectin T94G的基因多型性與年輕型高血壓族群有無頑固性高血壓具有相關性。
關鍵字: 年輕型高血壓、頑固性高血壓、adiponectin T94G基因多型性

關鍵字

年輕型高血壓 ； 頑固性高血壓 ； adiponectin T94G 基因多型性

並列摘要

Background: Young-onset primary hypertensives (YOHs) with resistant hypertension (RH) would have higher long-term cardiovascular risk. Adiponectin is a major adipocytokine and associated with level of blood pressure (BP). The present study examined whether functional adiponectin T94G polymorphism is associated with RH in the YOHs.
Method: We analyzed data from Academia Sinica Collaborative Study on Hypertension Genetics in Non-Aboriginal Taiwanese to compare adiponectin T94G polymorphism between those with and without RH in the YOHs (≦50 years old). The RH was defined as need of at least 3 drugs including a diuretic to control BP. Gene polymorphisms were analyzed by polymerase chain reaction.
Result: 861 YOHs were enrolled in the present study. Those with RH (n = 54) were older and had higher waist, triglyceride, BUN, creatinine, uric acid, aldosterone, C-reactive protein (CRP) and fibrinogen. For the adiponectin T94G polymorphism in the allelic model, the odds ratio (OR) of RH was 2.45 (p = 0.001) and there is a linear relationship between allele numbers and presence of RH (p = 0.001). The binary regression analysis indicated that T94G polymorphism (OR = 2.766, 95% CI = 1.434-5.338, p = 0.002), age (OR = 1.103, CI = 1.040-1.169, p = 0.001), uric acid (OR = 1.322, 95% CI = 1.126-1.552, p = 0.001), CRP (OR = 2.769, 95% CI = 1.535-4.992, p = 0.001) and aldosterone (OR = 1.004, 95% CI = 1.002-1.006, p < 0.001) were independently associated with the presence of RH.
Conclusion: In the Chinese population we found adiponectin T94G polymorphism is associated with RH in the YOHs.
Key words: young-onset hypertension、resistant hypertension、adiponectin T94G polymorphism

並列關鍵字

young-onset hypertension ； resistant hypertension ； adiponectin T94G polymorphism

參考文獻

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