摘要目的 采用改进的实验方法研究血管紧张素转换酶(ACE)基因rs1799752多态性与2型糖尿病(T2DM)肾病(DKD)的相关性,并探讨该多态性与环境因素(吸烟、肥胖)的交互作用对DKD的影响.方法 病例对照研究.选择2016年6月至2018年3月中日友好医院收治的T2DM合并DKD患者[DKD(+)组]和T2DM不伴DKD患者[DKD(-)组]各300例为研究对象.采用改进的PCR-毛细管电泳法进行基因分型.统计学分析两组受试者的临床生化指标和ACE基因I/D多态性不同基因型及等位基因频率,进一步按吸烟、肥胖状况分组进行多因素回归分析.结果 DKD(+)组患者DD基因型及D等位基因频率均高于DKD(-)组[DD基因型:15.0％(45例)比7.3％(22例),χ2=10.8,P=0.004;D等位基因频率:36.5％(219例)比28.0％(168例),χ2=9.92,P=0.02].多因素Logistic回归分析显示,在隐性和加性遗传模型中,D等位基因与DKD发病风险显著相关(校正后,隐性模型:OR=1.45,95％CI:1.06～2.00,P=0.022;加性模型:OR=1.41,95％CI:1.04～1.90,P=0.025).在吸烟组和肥胖组,D等位基因在显性和隐性模型中与DKD的发病显著相关(校正后均P<0.05),表明吸烟组和肥胖组的D等位基因携带者有更高的DKD发病风险.而在非吸烟组和非肥胖组,未校正和校正后的3种模型中均未发现基因型及等位基因与DKD相关(均P>0.05).结论 ACE基因I/D多态性与2型糖尿病患者DKD的发病相关,D等位基因是DKD发病的易感基因,DD基因型是2型糖尿病合并DKD的危险因素.ACE基因I/D多态性可能与吸烟、肥胖环境因素协同促进DKD的发病.

abstractsObjective To explore the interaction of angiotensin converting enzyme (ACE) insertion/deletion(I/D) polymorphism(rs1799752)with diabetic kidney disease (DKD) development as well as its interaction with smoking and obesity in Chinese type 2 diabetic mellitus (T2DM) using the improved experiment method. Methods From June 2016 to March 2018, 300 T2DM patients with DKD [DKD(+)] and 300 T2DM patients without DKD[DKD(-)] were selected from China-Japan Friendship Hospital. The improved Triple Primer Method that combined PCR with capillary electrophoresis was established in this study to detect the ACE genotype. The relevant clinical data as well as the frequencies of genotype and allele of ACE gene I/D polymorphism between two groups were statistically analyzed. Patients were further grouped based on smoking status and obesity for multivariate regression. Results Frequency of the DD genotype and D allele were significantly higher in DKD(+) group than in DKD(-) group [DD genotype:15.0％ (45 cases) vs 7.3％(22 cases),χ2=10.8, P=0.004;D allele:36.5％(219 cases) vs 28.0％(168 cases),χ2=9.92, P=0.02]. Multivariate logistic regression analysis found that D allele of rs1799752 was associated with a significantly higher risk of DKD in both recessive model(OR=1.45, 95％CI:1.06-2.00, P=0.022 after adjustments) and additive model(OR=1.41, 95％CI:1.04-1.90, P=0.025 after adjustments). In the smoker group and the obese group, D allele showed significant relationship with DKD incidence (P<0.05 after adjustments) in both recessive model and dominant model. No such relationships were observed in non-smoker group and non-obese group (P>0.05). Conclusions I/D polymorphism of ACE gene is associated with the incidence of DKD in T2DM patients. DD genotype of the ACE gene is the risk factor for T2DM patients with DKD. D allele may increase DKD incidence in the presence of smoking and obesity.