飞行员冠心病危险因素分析及LOX-1基因多态性与飞行员冠心病的关系研究

发布时间：2019-07-05 15:47

【摘要】： 背景: 在飞行人员中冠心病心肌梗塞时有发生,对飞行安全是一种严重威胁,可能导致飞行员空中突然失能而产生严重后果。冠心病心肌梗塞最重要的病理因素是冠状动脉粥样硬化致血管管腔狭窄,而动脉粥样硬化的病因目前尚未完全清楚,大量研究表明动脉粥样硬化与多种危险因素有直接的关系,在各种危险因素作用下,动脉内皮损伤,导致内皮功能紊乱,并逐渐形成动脉粥样硬化病变。对冠心病的防治,只有综合全面地改善多因子危险谱,才能使危险得以较大幅度的降低,故控制危险因素是预防冠心病的根本。研究表明35～59岁的男性发生冠心病的危险至少有80%可归因于高脂血症、高血压、吸烟这三个因素。在我军飞行员人群中,冠心病危险因素分布情况如何,其分布是否与普通人群不同尚待研究。另遗传因素在冠心病发生中的作用也是不容忽视的,目前许多研究检测了基因多态性与冠心病心肌梗塞的关系。血凝素样氧化低密度脂蛋白受体-1(LOX-1)是1997年由日本学者首先发现的,是氧化低密度脂蛋白(ox-LDL)的特异性受体。LOX-1在动脉内皮细胞、巨噬细胞、血管平滑肌细胞、成纤维细胞和血小板上均有表达,在高血压、糖尿病、高脂血症等促进动脉粥样硬化发生的病理条件下表达增加,在动脉粥样硬化斑块中也发现存在高表达。研究发现LOX-1基因3′UTR C/T多态性与动脉粥样硬化及急性心肌梗塞的危险性相关。我军飞行员中LOX-1基因多态性是否与冠心病的发生有关,是否影响血脂水平等其它冠心病危险因素,尚待研究。目的: 1、调查我军飞行人员冠心病相关危险因素的暴露情况,分析飞行员冠心病危险因素分布与普通人群是否存在差异; 2、检测飞行员LOX-1基因3′UTR C/T多态性情况,探讨LOX-1基因多态性与飞行员冠心病及其危险因素的关系。方法: 1、制定《飞行员冠心病危险因素调查表》,采用现况调查的方法对297名飞行员的一般情况及健康状况进行详细的调查,分析飞行员冠心病危险因素分布情况。采用u-检验、单因素方差分析及Logistic回归分析进行统计分析; 2、应用实时荧光PCR技术,采用病例-对照研究的设计方法,检测20例经冠状动脉造影证实为冠状动脉粥样硬化的飞行员和20例健康对照飞行员LOX-1基因多态性,比较该基因多态性在两组中的分布情况,以及该基因多态性与冠心病及其危险因素的关系,采用两样本t检验和χ2 -检验进行分析。结果: 1、297例飞行员中吸烟、饮酒、饮食习惯不良、超重、血脂异常、高血压、糖尿病等冠心病危险因素占总人数的比例分别为62.63%、60.94%、48.82%、38.72%、26.60%、10.44%、3.03%。在35～44岁年龄段,吸烟和饮酒构成比最高。飞行员冠心病危险因素构成与我国普通20岁以上男性人群有所不同,吸烟、饮酒、超重及血脂异常发生率显著偏高,而高血压、糖尿病患病率较低。多因素Logistic回归分析显示飞行员冠心病危险因素包括:年龄超过45岁、高血压病史、冠心病家族史、吸烟超过200支年、TC水平超过6.22mmol/l、HDL低于1.04mmol/l,其优势比(OR)值以年龄超过45岁为最高(12.78),其次为吸烟超过200支年(10.12)。将297名飞行员按吸烟量分组,比较各吸烟组间血脂水平发现,吸烟量超过200支年组,血TC、TG、LDL-C、TC/HDL-C水平显著高于不吸烟组及吸烟量低于100支年组,而HDL-C水平显著低于后者(p㩳0.05)。 2、在我们所观察的飞行员中LOX-1基因3′UTR C/T基因多态性表现出三种基因型,CC、CT及TT。在年龄、飞行时间、吸烟率、血脂、同型半胱氨酸等指标无显著差异的情况下,在病例组飞行员中T等位基因频率较对照组高(0.50 vs 0.275, p㩳0.05),并CT+TT基因型频率也显著高于对照组(0.80 vs 0.50, p㩳0.05),另按基因型分组比较,TC、TG、HDL、LDL、吸烟率、Hcy等指标无显著性差异(p 0.05)。结论: 1、目前我军飞行员中广泛存在着冠心病危险因素,其中以吸烟所占比例最高。飞行员冠心病危险因素分布与我国普通20岁以上男性人群有所不同,吸烟、饮酒、超重及血脂异常发生率较高,而高血压、糖尿病患病率较低。与飞行员冠心病显著相关的因素主要有年龄超过45岁、高血压病史、冠心病家族史、吸烟超过200支年、总胆固醇水平超过6.22mmol/l、HDL低于1.04mmol/l。 2、吸烟是导致飞行员血脂代谢异常的因素之一。 3、LOX-1基因多态性与飞行员冠心病相关,LOX-1基因3′UTR变异基因型(CT+TT)可能与飞行员冠心病患病风险有关,T等位基因携带者可能存在更高的患病风险,但LOX-1基因多态性与吸烟、血脂、Hcy等冠心病危险因素无明显相关性,提示LOX-1基因多态性可能是飞行员冠心病的一个独立预测因素。
文内图片：

图片说明：LOX-1在动脉粥样硬化发生发展过程中的作用注：示LOX-1的作用点
[Abstract]:Background: In flight personnel, coronary heart disease and myocardial infarction occur frequently, which is a serious threat to flight safety, which may lead to a sudden loss of air in the air of the pilot The most important pathological factors of myocardial infarction in coronary heart disease are the stenosis of the vascular lumen caused by coronary atherosclerosis, and the cause of atherosclerosis is not yet completely clear, and a large number of studies have shown that atherosclerosis has a direct relationship with a variety of risk factors and is made in various risk factors. With the use of lower and arterial endothelial damage, endothelial dysfunction is caused, and atherosclerosis is gradually formed. The prevention and treatment of coronary heart disease can only comprehensively improve the multi-factor risk spectrum, so that the risk can be reduced greatly, so the control risk factors are the prevention of coronary heart disease. The study shows that at least 80% of the risk of coronary heart disease in men from 35 to 59 years of age can be attributed to hyperlipidemia, hypertension, and smoking. Factors: The distribution of the risk factors of coronary heart disease in our pilot population is different from that of the general population. The role of another genetic factor in the occurrence of coronary heart disease is not to be ignored. At present, many studies have detected the gene polymorphism and the myocardial infarction of coronary heart disease. The relationship. Hemagglutinin-like oxidized low-density lipoprotein receptor-1 (LOX-1) is first discovered by Japanese scholars in 1997, and is the specificity of oxidized low-density lipoprotein (ox-LDL). The receptor. LOX-1 is expressed in the vascular endothelial cells, macrophages, vascular smooth muscle cells, fibroblasts and platelets, and is expressed in the pathological conditions of hypertension, diabetes, and hyperlipidemia to promote the occurrence of atherosclerosis. An increase in the presence of high in atherosclerotic plaques Expression of LOX-1 gene 3-UUTR C/ T polymorphism and the risk of atherosclerosis and acute myocardial infarction It is related to whether the polymorphism of LOX-1 gene in our pilots is related to the occurrence of coronary heart disease, and whether the risk factors of other coronary heart diseases such as the level of blood lipid and other coronary heart disease have yet to be Research. Objective:1. To investigate the risk factors of coronary heart disease in the flight personnel of our army, and to analyze the risk factors of coronary heart disease in pilots. Is there a difference in the population;2. Test the pilot LOX-1 gene 3. The Study of the Polymorphism of the UTR C/ T and the Study on the Polymorphism of LOX-1 and the Caps of the Pilots heart disease and heart disease The relationship between the risk factors and the risk factors. Methods:1. The questionnaire of the risk factors of coronary heart disease of pilots was established. The general condition and health status of 297 pilots were investigated by the method of current status survey. The risk factors of coronary heart disease were analyzed in this paper. u-test, one-factor analysis of variance and L-test were used. the statistical analysis was carried out by the logistic regression analysis;2, real-time fluorescence was applied A case-control study was used to detect the polymorphism of LOX-1 gene in 20 pilots and 20 healthy control pilots confirmed by coronary angiography as coronary atherosclerosis and to compare the distribution of the gene polymorphism in the two groups. and the correlation between the polymorphism of the gene and the coronary heart disease and the risk factors system Results: The proportion of risk factors of coronary heart disease (CHD), such as smoking, drinking, bad diet, overweight, dyslipidemia, hypertension, and diabetes, were 62.63%, 60.94% and 48.82%, respectively. 38.72%, 26.60%, 10.44%,3 In the age group of 35 to 44, smoking and drinking are the highest. The risk factors of the coronary heart disease of the pilot are different from those of the men over the age of 20 years in China. Smoking, alcohol consumption, overweight The incidence of dyslipidemia is high, and the prevalence of hypertension and diabetes is low. The multivariate logistic regression analysis shows that the risk factors for coronary heart disease include: the age of over 45 years, the history of hypertension, family history of coronary heart disease, smoking more than 200 years, TC level of more than 6.22 mmol/ l and HDL lower than 1.04 mmol/ l, the odds ratio (OR) value is the highest (OR) value at an age of more than 45 years ( (12.78), followed by smoking for more than 200 years (10.12). A total of 297 pilots were grouped according to the amount of smoking, and the level of blood lipids in each of the smoking groups was compared, and the level of serum TC, TG, LDL-C, TC/ HDL-C was significantly higher than that of non-smoking group and less than 100 in the non-smoking group. in that support group, the level of HDL-C was significantly lower than the lat (p? 0.05).2. LOX-1 gene 3 in the pilot we observed The frequency of T allele in the pilot of the case group was higher than that of the control group (0.50 vs.275, p? 0.05) and the CT + TT genotype in the case of age, time of flight, smoking rate, blood fat, and homocysteine. The frequency was also significantly higher in the control group (0.80 vs. 0.50, p? 0.05), and the other by the genotype group, TC, TG, HD L,L There was no significant difference in the indexes of DL, smoking and Hcy (p.05). Conclusion: 1. There is a wide range of risk factors of coronary heart disease among our pilots, among which the proportion of smoking is the most. The risk factors of the coronary heart disease in pilots are similar to those of the men in the normal age of 20 years in China. The incidence of smoking, drinking, overweight and dyslipidemia is high, and the prevalence of hypertension and diabetes is low. The factors associated with the coronary heart disease of pilots are mainly of the age of over 45 years, the history of hypertension, family history of coronary heart disease, and smoking more than 200 years. with a total cholesterol level of more than 6.22 mmol/ l, HD, "L is lower than 1.04 mmol/ l.2, and smoking is one of the factors leading to the abnormal blood lipid metabolism of the pilot.3. The polymorphism of LOX-1 gene is related to the coronary heart disease of the pilot. The variant genotype (CT + TT) of LOX-1 gene may be related to the coronary heart disease of the pilot. Risk-related, T-allele carriers may have a higher risk of disease, but the LOX-1 gene polymorphism is associated with coronary heart disease such as smoking, blood lipid, and Hcy.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R541.4;R85

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