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目的探讨血管紧张素I转换酶(ACE)基因多态性与糖尿病肾病(DN)发生、发展的关系。方法用PCR技术分别 检测90例无DN并发症的2型糖尿病患者和137例不同程度蛋白尿的DN患者ACE基因I/D多态基因型。结果DN 患者与无 DN的糖尿病患者相比,DD型基因的频率和 D等位基因的携带率明显较高(26.8%vs 16.67%、48.19%vs 31.11%),Ⅱ型基因的频率和 I等位基因的携带率明显较低(28.46%vs 54.44%,51.09%vs 68.89%),均有显著性差异 (P<0.001和P<0.05);DD型患者的血压明显高于Ⅱ型基因患者。随着DN病情发展的不断加重,DD型出现频率增加, Ⅱ型出现频率减少,肾功能不全组 DD型频率(39.13%)显著高于临床蛋白尿组(27.45%)及微量蛋白尿组(20.63%),而 Ⅱ型频率(21.74%)显著低于其余两组(27.45%、31.75%)。结论 ACE基因I/D多态性和 DN易感性密切相关。在 DN的 发展过程中,DD基因型是肾功能不全的危险因素,DD型患者预后不佳;Ⅱ型基因起保护作用,可延缓病情进展,提示 ACE基因I/D多态性的检测可作为DN发病和病情进展的预?
Objective To investigate the relationship between angiotensin I converting enzyme (ACE) gene polymorphism and the occurrence and development of diabetic nephropathy (DN). Methods ACE gene I / D polymorphism was detected by PCR in 90 patients with type 2 diabetes without DN complications and 137 with DN patients with different degrees of proteinuria. Results The frequencies of DD genotype and D allele in DN patients were significantly higher than those without DN (26.8% vs 16.67%, 48.19% vs 31.11%, respectively) The frequencies of type Ⅱ and I alleles were significantly lower (P <0.001 and P <0.001, respectively) P <0.05). The blood pressure of DD patients was significantly higher than that of patients with type II genes. As the progression of DN progressed, the frequency of type DD increased and the frequency of type II decreased. The frequency of type DD in renal insufficiency (39.13%) was significantly higher than that in clinical proteinuria (27.45%) and microalbumin (20.63%), while the frequency of type Ⅱ (21.74%) was significantly lower than the other two groups (27.45%, 31.75%). Conclusion The ACE gene I / D polymorphism is closely related to the susceptibility to DN. In the development of DN, DD genotype is a risk factor of renal insufficiency, and DD type patients have a poor prognosis. Type II gene may play a protective role in retarding the progression of the disease, suggesting that detection of ACE gene I / D polymorphism may be used as DN onset and progression of the disease?