血管紧张素转换酶基因多态性对苯那普利治疗糖尿病肾病疗效的影响

按照血管紧张素转换酶 (ACE)基因插入 /缺失多态性不同 ,将 92例 2型糖尿病肾病患者分为II型组 31例 ,ID型组 30例及DD型组 31例。用苯那普利治疗 6个月后 ,观察治疗前后各组的尿白蛋白排泄率 (UAER)、平均动脉压 (MABP)、肌酐清除率 (Ccr)及ACE的变化。结果 :苯那普利治疗后 3组UAER、MABP、ACE均下降 ,以II型组下降幅度最大 (分别为 58.6%、2 .87kPa和 72 .3% ) ,DD型组下降幅度最小 (P <0 .0 5) ;而Ccr在DD型组下降幅度最大 ,II型组下降幅度最小 (P <0 .0 5) ;多元线性逐步回归分析显示 :ACE基因型对UAER下降率有显著回归效果(R2 =0 .72 ,P <0 .0 0 1 )。提示 :ACE基因型影响血管紧张素转换酶抑制剂 (ACEI)对糖尿病肾病的疗效 ,II基因型患者对ACEI治疗更为敏感。

Effect of Angiotensin Converting Enzyme Gene P olymorphism on the Renoprotective Responsiveness to Benazepril in Dlabetic Nep hropathy

The punpose of the research is to test the potential role of an insertion/deletion polymorphism of angiotensin converting enzyme(ACE) gene on the renoprotective responsiveness to benazepril in type 2 diabetes mellitus with nephropathy. Ninety two cases with diabetes nephropathy were classified according to the genotype of the ACE gene into three groups:31 cases with II genotypes, 30 with ID and 31 with DD. Mean arterial blood pressure(MABP), urinary albuminexcretion rate(UAER), creatinine clearance rate(Ccr) and ACE levels were measured before and after the six month treatment of benazepril(no differences in drug dose between the groups).Initiation of the 6 month treatment with benazepril induced a significant drop in MABP, UAER and ACE levels in all three groups( P <0.05), but the reduction was significantly greater in patients with II genotype (UAER 58.6%, MABP 2.87 kPa, ACE 72.3 %), compared with patients with either ID or DD genotype( P <0.01, respectivly). A mild decline in the creatinine clearance rate was seen in all groups after the initiation of benazepril, but the change was highest in DD group and lowest( P <0.05) in II group . A multiple linear regression analysis revealed that the ACE gene polymorphism influenced the decline in albuminuria after initiation of ACE inhibition( R 2=0.72, P <0.001). The patients with II genotype are particularly susceptible to commonly advocated renoprotective treatment.