Please use this identifier to cite or link to this item: http://hdl.handle.net/11455/20611
標題: 血管收縮素轉化基因之插入/刪除多型性和中國人第2型糖尿病新陳代謝症候群相關性之研究
ACE gene Insertion/Delection polymorphism associated with metabolic syndrome in Chinese type 2 diabetic patient
作者: 黃雅芳
關鍵字: 血管收縮素轉化基因;第2型糖尿病;新陳代謝症候群
出版社: 生命科學院碩士在職專班
摘要: 
研究指出血管收縮素轉化基因之插入/刪除(Angiotensin Converting Enzyme Insertion/Deletion,ACE I/D )多型性,和糖尿病、高血壓、心血管疾病及糖尿病腎病變有關,血漿血管收縮素轉化濃度亦被發現和第2型糖尿病病人的三酸甘油脂和總膽固醇有關。
本研究的目的為探討是否血管收縮素轉化基因之插入/刪除多型性和新陳代謝症候群有相關。
共收集711位患有第2型糖尿病病人及750位接受健康檢查之受檢人參與此研究,血管收縮素轉化基因之插入/刪除多型性以PCR方法檢測,新陳代謝症候群之定義是以1998年世界衛生組織所建議之標準。
結果顯示711位患有第2型糖尿病病人中有534 (75.1%) 位符合新陳代謝症候群的標準。於對照族群中新陳代謝症候群之盛行率以血管收縮素轉化基因多型性分組分別為I I 9.4 %,I D 11.5 %,DD 15.4 %,而在第2型糖尿病病人則新陳代謝症候群之盛行率分別為I I 68.6 % ,I D 79.2 % ,DD 86.1 % ,ACE 基因之I/D多型性對第2型糖尿病之病人合併新陳代謝症候群是有意義的相關(P=0.001)。當對照族群和第2型糖尿病病人一起分析時,則新陳代謝症候群盛行率為I I 37.9 %,I D 44.5 %,DD 51.0 %,ACE 基因之I/D多型性和新陳代謝症候群,仍然有有意義的相關 (P=0.003),第2型糖尿病病人有DD基因型者亦發現有較高的血脂異常情形
(II/I D/DD = 43.1 %,53.1 %,65.8 %,P <0.001) 及白蛋白尿情形
(II/I D/DD = 36.0 %,44.6 %,50.6 %,P = 0.018),而且亦有較高的血清三酸甘油脂(II/ID/DD=155±114 mg/dl,170±140 mg/dl,199± 132 mg/dl,P <0.05),另外,對照族群有DD基因型者,亦發現有較高的白蛋白尿或腎病變盛行率(II/ID/DD= 5.7 %,14.0 %,15.4 %
P =0.001),但在對照族群之血脂異常之盛行率則並沒有統計上的差異。當對照組和第2型糖尿病病人一併分析,則血管收縮素轉化基因型於血脂異常及腎性蛋白尿有統計上的相關,分別為血脂異常,(II/ID/DD= 34.7 %,41.3 %,52/2 %,P <0.001),腎性蛋白尿或腎病變(II/ID/DD= 20.3 %,28.9 %,33.1 %,P <0.001),另第2型糖尿病病人有新陳代謝症候群和沒有新陳代謝症候群相比較,發現有較高的尿酸數值(6.4±1.8 mg/dl vs 5.3±1.4 mg/dl,P <0.001)。
在中國人的第2型糖尿病病人,血管收縮素轉化基因之I/D多型性已被發現和新陳代謝症候群有相關,這個發現可以提供遺傳學上的證據來解釋在新陳代謝症候群有遺傳群聚的傾向,且本研究結果支持renin-angiotensin system在第2型糖尿病病人中造成病理生理學的代謝異常有相當重要的角色。

Angiotensin-Converting Enzyme (ACE) Insertion/Deletion (I/D) polymorphism has been shown to be associated with diabetes, hypertension, coronary artery diseases, and diabetic nephropathy, and plasma ACE concentration has been found to be associated with plasma triglyceride and total cholesterol levels in patients with type 2 diabetes。
The goal of this study was to investigate whether ACE gene I/D polymorphism can be associated with metabolic syndrome.
711patients with type 2 diabetes and 750 control subjects were studied. The ACE I/D polymorphism was determined by polymerase chain reaction. The definition and criteria of metabolic syndrome used in this study matched those proposed in the 1998 WHO classification.
Our result revealed that Five hundred and thirty-four out of 711 patients with type 2 diabetes (75.1 %) fulfilled the criteria for metabolic syndrome. The prevalence of metabolic syndrome in control subjects with II, ID, and DD genotype were 9.4 %, 11.5 %, and 15.4 %, respectively, and in patients with type 2 diabetes were 68.6 %, 79.2 % and 86.1 %, respectively. The ACE I/D polymorphism was significantly associated with the syndrome in patients with type 2 diabetes (p=0.001). When pooling the controls with diabetes patients, the prevalence of metabolic syndrome in whole study group with II, ID, and DD genotype were 37.9 %, 44.5 % and 51.0 %, respectively and ACE I/D polymorphism was still significantly associated with the metabolic syndrome (p=0.003). Diabetic patients with DD genotype were also found to have a higher prevalence of dyslipidemia (II/ID/DD=43.1% / 53.1% / 65.8%, p< 0.001) and albuminuria (II/ID/DD=36.0% /44.6% / 50.6%, p=0.018), and have higher serum triglyceride levels (II, ID, DD= 155 ± 114 mg/dl, 170 ± 140 mg/dl, and 199 ± 132 mg/dl respectively, p<0.05).
Control subjects with DD genotype were also found to have higher prevalence of albuminuria or more advanced nephropathy (II/ID/DD= 5.7% /14.0% /15.4%, p= 0.001), while the prevalence of dyslipidemia was not found to be statistically different in the control group. When pooling the controls with diabetes patients, ACE genotype could still be significantly associated with dyslipidemia (II/ID/DD=34.7%/41.3%/52.2%, p<0.001) and albuminuria or more advanced nephropathy (II/ID/DD=20.3%/28.9%/33.1%, p<0.001). Diabetic patients with metabolic syndrome were found to have higher serum uric acid levels than those without metabolic syndrome (6.4 ± 1.8 mg/dl vs 5.3 ± 1.4 mg/dl, p<0.01).
The ACE I/D polymorphism was found to be associated with metabolic syndrome in Chinese patients with type 2 diabetes. This finding may provide genetic evidence to explain the clustering of metabolic syndrome, and suggests that renin-angiotensin system is involved in the pathophysiology of metabolic derangement in patients with type 2 diabetes.
URI: http://hdl.handle.net/11455/20611
Appears in Collections:生命科學系所

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