ACE基因插入/缺失多态性与儿童膀胱输尿管反流——基于14个病例-对照研究的Meta分析

Angiotensin Converting Enzyme Gene Insertion / Deletion Polymorphism and Vesicoureteral Reflux in Children: a Meta-analysis of 14 Case-control Studies

目的：采用Meta分析的方法探讨ACE I/D基因多态性与膀胱输尿管反流（VUR）患病风险的关联性。方法：系统检索Pub Med、CNKI、Embase数据库中所有相关研究,检索时限为各数据库建库至2015年2月4日。2位研究者独立地按纳入和排除标准筛选文献、提取数据。运用Stata12.0软件进行Meta分析。根据研究间异质性,关联强度运用固定或随机效应模型的比值比（OR）及其95%可信区间（CI）表示。结果：14个病例—对照研究符合纳入标准,共计1 197例VUR患者和1 320例健康对照。Meta分析结果显示ACE I/D基因多态性与VUR患病风险关联性具有统计学意义（D vs.I：OR=1.28,95%CI=1.06~1.54,P=0.01;DD vs.II：OR=1.44,95%CI=1.12~1.85,P=0.01;DD vs.DI＋II：OR=1.49,95%CI=1.23~1.79,P〈0.01;DD＋DI vs.II：OR=1.20,95%CI=0.84~1.72,P=0.31）。根据种族进行亚组分析显示出不同的关联性。在土耳其人群,除DI vs.II基因模型外,其余基因模型均有统计学意义。在高加索人种,DD vs.DI＋II基因模型具有统计学意义。在亚洲人种,DI vs.II基因模型具有统计学意义。结论：本研究显示ACE DD基因型和D等位基因可能增加儿童VUR患病风险。基于现有研究的缺陷,它们之间的关联性仍需开展大样本、校正各种危险因素的研究予以明确。

Objective To clarify the effect of ACE I/D polymorphism on vesieoureteral reflux risk by using meta-analysis ap- proach. Methods We systematically searched the PubMed, CNKI and Embase databases to identify all the potentially related studies published up to 4 February, 2015.Two reviewers independently selected studies and extracted data.The strength of the correlation was assessed by using odd ratio （OR） with its 95% confidence interval（CI） based on fixed or random effects model.The STATA 12.0 software was used for data analysis. Results A total of 14 case-control studies involving 1 197 VUR patients and 1 320 healthy controls met the eligibility criteria results of meta-analysis showed significant correla- tion between ACE I/D polymorphism and VUR risk （D vs. I：OR= 1.28,95%CI= 1.06- 1.54,P=0.O1;DD vs. II：OR= 1.44,95%CI= 1.12-1.85,P=0.01 ;DD vs. DI＋II：OR= 1.49,95%CI= 1.23-1.79,P〈0.01 ;DD＋DI vs. II：OR= 1.20,95% CI = 0.84 - 1.72, P = 0.31 ）. Subgroup analyses revealed varied results. In Turkish people, results of all the genetic＂ ＂ models oth, er than DI vs. II showed statistical significance;in Caucasians,DD vs. DI＋II showed statistical significance and in Asians,DI vs. II showed statistical significance.Conclusion Our meta-analysis indicated that the ACE I/D polymorphism might be as- sociated with incl：eased risk of VUR in children.However, due to the limitations, we suggest conducting additional studies with larger sample size and adjustment of various risk factors for further clarification.