Ⅱ型糖尿病肾病与血管紧张素酶活性的研究

Relationship between serum angiotensin I converting enzyme activity and diabetic nephropathy in patients with Type Ⅱ diabetes

观察３６例健康对照者，５８例无糖尿病肾病和５０例有糖尿病的Ⅱ型糖尿病病人的血管紧张素酶（ＡＣＥ）插入／缺失（Ｉ／Ｄ）基因型及血清ＡＣＥ活性。结果发现：虽然ＡＣＥＤＤ，ＩＤ，Ｉ型基因在三个群体中的分布差异无显著性，但血清ＡＣＥ活性在有肾病的尤在具Ｄ等位基因的Ⅱ型糖尿病组中明显高于无肾病组（Ｐ＜０．０５），正常对照组和单纯Ⅱ型糖尿病组的血清ＡＣＥ活性在各基因组间差异均无显著性。提示血清ＡＣＥ活性与Ⅱ型糖尿病的发生无关联；高血清ＡＣＥ活性在Ⅱ型糖尿病肾病的发生和发展中起一定的作用，或者可能是临床肾病后期发展的危险标志。

To clarify the relationship between serum angiotensin I converting enzyme (ACE) activity and Type Ⅱ diabetic patients with or without diabetic nephropathy. We examined 36 healthy controls, 58 Type Ⅱ diabetic patients without diabetic nephropathy, and 50 Type Ⅱ diabetic with diabetic nephropathy. The diabetic duration of all of Type Ⅱ diabetic patients was more than 5 years. All patients matched well in age and BMI. An insertion/deletion polymorphism of ACE gene was identified by polymerase chain reaction(PCR). Serum ACE activity was determined using spectrophotometry. Although the distribution of DD, ID, and II genotypes of the ACE gene did not differ among the three groups, serum ACE activity was significantly higher in Type Ⅱ diabetic patients with diabetic nephropathy than in that without diabetic nephropathy( P <0.05), especially in the groups with D allele of ACE gene. Serum ACE activity had no difference between healthy controls and Type Ⅱ diabetic patients without diabetic nephropathy. There is no association between serum ACE activity and Type Ⅱ diabetic patients without diabetic nephropathy in any genotype of ACE gene. The increasing serum ACE activity plays a role in the initiation of diabetic nephropathy or may serve as a risk marker for later development of overt diabetic nephropathy in Type Ⅱ diabetic patients.