转化生长因子β1基因多态性与高血压早期肾损害的关系及对缬沙坦个体化治疗作用的影响

The relationship between the gene polymorphism of TGF-β1 and early renal injury in patients with essential hy-pertension, and the effect of the gene polymorphism of TGF-βl on the individual treatment with valsartan

目的研究转化生长因子β1（transforming growth factor-β1，TGF-β1）基因＋869T／C多态性与其血清水平和高血压早期肾损害的关系，及对缬沙坦治疗高血压早期肾损害患者个体化治疗作用的影响。方法高血压早期肾损害患者给予缬沙坦治疗8周，在观察降压效果的同时，采用序列特异性引物聚合酶链反应检测TGF-β1基因＋869T／C多态性，采用双抗体夹心ABC—ELISA法测定治疗前后血清TGF-β1水平变化，采用放射免疫法测定治疗前后的尿微量白蛋白（microamount albumin，MA）水平。结果高血压早期肾损害患者TGF-β1基因＋869位点TT、TC、CC基因型间治疗前血压水平接近，差异无统计学意义（P〉0．05）；尿MA水平为CC型〉TC型〉TT型，CC型尿MA水平和后两型相比显著增高（P〈0．01）；血清TGF-B水平为CC型〉TC型〉TT型，各基因型间差异有统计学意义（P〈0．01），且尿MA水平和血清TGF-β1水平存在正相关（P〈0．05）。予缬沙坦治疗后，TT、TC、CC基因型的血压、尿MA水平、血清TGF-β1．水平均显著降低（P〈0．01）。3基因型间收缩压、舒张压降低值差异无统计学意义，尿MA水平降低的绝对值为CC型〉TC型〉TT型，CC型尿MA降低值高于后两型的降低值（P〈0．05），但3型间尿MA水平降低的百分比差异无统计学意义（P〉0．05）。血清TGF-β1．水平降低的绝对值为CC型〉TC型〉TT型，差异有统计学意义（P〈0．01），但3型间血清TGF-β1水平降低的百分比差异无统计学意义（P〉0．05）。结论（1）TGF-β1基因＋869位点CC基因型的高血压早期肾损害患者的肾损程度要高于Tr、TC型患者的肾损程度。（2）血清TGF-β1。水平可以准确反映高血压早期肾损害患者的肾损程度以及缬沙坦对肾脏保护功能的疗效。（3）不同TGF-β1基因型高血压早期肾损害患者对缬沙坦敏感性无差异，即缬沙坦在有效降压和保护肾脏功能的同时，可以有效地降低血清TGF-β1。水平，且不受TGF-β1基因多态性的影响。

Objective To analyze the association of transforming growth faetor-βl（TGF-β1） gene ＋ 869T/C polymorphism and the serum level of TGF-β1 in patients with early essential hypertension and early renal injury. To study the effect of the gene polymorphism of TGF-βl on the individual treatment with valsartan. Methods Eighty patients with early essential hypertension and early renal injury were treated with valsartan, and their polymorphism of TGF-β1 gene ＋ 869T/C was analyzed by sequence specific primers-polymerase chain reaction method. Before valsartan treatment and 8 weeks after the treatment, their urinary micmamount albumin （MA） levels were determined by using radioimmunity method, and their serum levels of TGF-β1 were determined by enzyme-linked immunosorbent assay. Results The blood pressure level of patients with TGF-β1 gene ＋ 869 CC genotype, Tr genotype, TC genotype showed no significant difference （P 〉 0.05） before treatment. The urinary MA level of the three genotypes was CC genotype＇s 〉 TC genetype＇ s 〉 Tr genotype＇ s in sequence, and the urinary MA level of CC genotype was significantly higher than that of TC genotype and of Tr genotype （ P 〈 0.01 ）. The serum levels of TGF-β1 in the flame genotypes was CC genotype＇ s 〉 TC genotype＇ s 〉 Tr genotype＇ s in sequence （P 〈 0.01 ）. There was statistically significant positive correlation between the urinary MA level and the serum level of TGF-β1 （P 〈 0.05）. After 8 weeks treatment with valsartan, there was significant decrease of the blood pressure, the urinary MA level, and the serum level of TGF - β1. However, the bloodpressure reduction of the three types had no statistical significant difference in sequence. The absolute value of urinary MA reduction was CC genotype＇ s 〉 TC genotype＇ s 〉 tiT genotype＇ s in sequence, the reduction absolute value of urinary MA in CC genotype was higher than that of TC genotype and of tiT genotype （ P 〈 0.05）, but the reduction percentage of the urinary MA in the three genotypes showed no statistically significant difference （ P 〉 0.05）. The reduction of serum levels of TGF-β1 was CC genotype＇ s 〉 TC genotype＇ s 〉 tiT genotype＇ s in sequence, there was significant difference between each other （ P 〈 0.01 ）. However, the reduction percentage of the serum level of TGF-β1 in the three types showed no statistically significant difference （P 〉 0.05）. Conclusion （1）The renal injury of CC genotype in patients with early essential hypertension and early renal injury is more serious than that ofTC genotype and of tiT genotype. （2） The serum level of TGF-β1 can accurately indicate the severity of the renal injury and the protective effect on kidney with valsartan in patients with essential hypertension and early renal injury. （3）The treatment effect of valsartan in the patients with different TGF-β1 ＋ 869T/C genotype has no difference, i.e., besides effectively decreasing the blood pressure and protecting the renal fimction, valsartan can reduce the serum level of TGF-β1 without the influence of the gene polymorphism of TGF-β1.