血管紧张素转换酶基因多态性与2型糖尿病肾病

Angiotensin converting enzyme gene polymorphism and Type 2 diabetic nephropathy

目的 :前瞻性地探讨血管紧张素转换酶 (ACE)基因插入 /缺失 (I/D)多态性与 2型糖尿病肾病的关系。方法 :应用PCR方法检测 6 6名尿白蛋白排泄率 (UAE)正常的 2型糖尿病患者 ,同时测定体重指数 (BMI)、平均动脉压 (MAP)、空腹血糖 (FBS)、血肌酐 (Scr)、糖化血红蛋白 (HbA1c)、UAE ;在严格控制血糖、血压的情况下随访5年 ,每年复查一次UAE及Scr。结果 :6 6例受试者退出 8例 ,退出率为 12 % ;ACEII,ID ,DD 3种基因型在入组和终点时各临床参数 (BMI,MAP ,FBS ,Scr,HbA1c ,UAE)差异无显著性 (P >0 .0 5 ) ;到达终点时 ,各组DN发生率 (II 4 5 .8% ,ID 5 2 .3% ,DD 4 6 .1% )及UAE的变化差异无显著性 (P >0 .0 5 )。结论 :ACE基因I/D多态性与中国汉族 2型糖尿病病人DN的发生和发展无关联 ,ACEDD型基因可能不是预测中国汉族 2型糖尿病病人DN发生、发展的有用指标。

Objective To prospectively clarify the relationship between angiotensin converting enzyme (ACE) gene insertion/deletion(I/D) polymorphism and diabetic nephropathy (DN) in Type 2 diabetic patients. Methods We examined 66 Type 2 diabetic patients with normal buminure. All patients suffered from diabetes mellitus for more than 5 years and matched well in age, body mass index (BMI),mean arterial pressure (MAP), fasting blood sugar (FBS), and urinary excretion of albumin (UAE). Patients were classified into 3 groups according to genotypes of ACE. ACE gene I/D polymorphism was identified by polymerase chain reaction (PCR). The patients were followed up for 5 years and their UAE, serum creatinine (Scr), and HbA1c were checked once a year. Results Eight subjects (12%) were discontinued prematurely. At the end of the study, there were no significant differences in the clinical parameters such as BMI, MAP, FBS, HbA1c, UAE, and Scr among the 3 groups (P>0.05), and also in DN incidence in Type 2 diabetic patients among the 3 groups (II 45.8%,ID 52.3%, and DD 46.1%,respectively, P>0.05 ). The increased degree of UAE among the 3 groups was similar at the end-point of the study (P>0.05). Conclusion The DD genotype of ACE gene may not be a clinically useful genetic marker for predicting the genesis and development of DN in Type 2 diabetic patients in Chinese. There is no association between ACE gene I/D polymorphism and the genesis and development of DN in Type 2 diabetic patients.