2型糖尿病患者ACE基因与肱动脉内皮依赖性血管舒展功能的关系

Angiotensin-converting enzyme gene and the brachial artery endothelial dysfunction in type 2 diabetes without angiopathy

目的 研究 2型糖尿病患者血管紧张素转换酶 (angiotensin convertingenzyme ,ACE)基因与内皮功能异常的关系。方法 选择 110例无血管并发症的 2型糖尿病患者 ,应用PCR技术检测其ACE基因型 ,同时采用高分辨血管外超声法检测肱动脉血流介导的内皮依赖性血管舒展功能和硝酸甘油 (glyc eryltrinitrate ,GNT)介导的内皮非依赖性血管舒展功能。同时 ,选择年龄、性别匹配的 5 0名健康个体作为对照。结果 在 2型糖尿病组和对照组中 ,内皮依赖性血管舒展功能在DD型分别为 3 .3 8%和 3 67% ,明显低于II型的 4 12 %和 4.68% (P <0 .0 5 ) ;基础血管内径 (D0 ) ,GNT诱导的内皮非依赖性血管舒展功能及基础血流在不同基因型组间差异无显著性 (P >0 .0 5 )。多元逐步回归分析显示 ,在 2型糖尿病患者中 ,血流介导的血管舒张功能与年龄、血管内径、低密度脂蛋白胆固醇、脂蛋白 (a)、D等位基因、病程、空腹血糖、餐后 2h血糖、糖化血红蛋白呈负相关 (P <0 .0 0 0 5 )。结论 ACEDD基因型降低早期 2型糖尿病患者及正常人内皮依赖性血管舒展功能。

Objective To investigate the relationship between angiotensin converting enzyme(ACE) gene and endothelial dysfunction. Methods One hundred and ten type 2 diabetic patients without angiopathy were selected randomly, and PCR technique was used to determine their ACE genotypes. High resolution ultrasonography was performed to measure the changes in brachial artery diameter at rest, after reactive hyperemia (with increased flow producing an endothelium-dependent dilation) and after sublingual glyceryltrinitrate (GNT, an endothelium-independent dilator). Meanwhile, 50 healthy individuals were selected randomly as controls. Results In type 2 diabetes mellitus and control groups, the percentages for flow-mediated arterial dilation in patients with DD genotypes were 3.38% and 3.67% respectively, which were significantly lower than those in patients with II genotypes (4.12% and 4.68% respectively, P<0.05). The baseline blood vessel size, baseline blood flow and GNT induced dilation in both groups showed no significant differences among ACE genotypes (P>0.05). By multiple stepwise regression analysis, reduced flow-mediated arterial dilation was associated with age, baseline vessel size, low density lipoprotein cholesterol(LDL-C), Lp(a), D allele, fasting blood glucose(FBG), postparandial blood glucose (PPBG), HbA1c, duration of diabetes in type 2 diabetic patients (P<0.0005). Conclusion ACE DD genotype is related to endothelium-dependent arterial dilation in the early stage of type 2 diabetes mellitus and in healthy individuals.