Microalbuminuria in relation to metabolic control and blood pressure in adolescents with type 1 diabetes

Introduction

The objective of this study was to assess the frequency of microalbuminuria and the relationship with other risk factors for the development of diabetic nephropathy.

Material and methods

Our cross-section study involved a group of 60 adolescence of both sexes, mean age 15.3 ±2.43 years with mean duration of diabetes 7.74 ±3.44 years. Albumin excretion rate was measured on 2-3 samples of the first morning urine in the period below 6 months and persistent microalbuminuria was defined if its increased in two out of three urine specimens. Ambulatory blood pressure was monitored (ABPM, SpaceLabs 90207).

Results

Microalbuminuria developed in 13.3% of adolescents with mostly completed sexual development, statistically significantly poorer metabolic control (9.79% vs. 8.7%) and higher BMI (23.59 kg/m² vs. 20.85 kg/m²) than in the patients with normoalbuminuria. The mean night-time systolic blood pressure (SBP) was statistically significantly higher in microalbuminuric patients than in normoalbuminurics. The nocturnal dip was reduced in 41.7% of our patients; 38.5% of nondippers were in normoalbuminuric and 62.5% in microalbuminuric patients.

Conclusions

Diabetic adolescents require particular attention in order to minimize the factors such as high HbA_1c, elevated body mass index and night-time SBP in the development of incipient nephropathy.     

肿瘤坏死因子α基因启动子区域-1031T/C多态与不稳定性心绞痛的相关性

目的 研究肿瘤坏死因子α(tumor necrosis factor-alpha,TNF-α)基因启动子区域-1031T/C多态与汉族不稳定性心绞痛的相关性.方法 采用MALDI-TOF质谱检测方法,在299例不稳定性心绞痛患者和202名健康对照者中,对TNF-α基因启动子区域的T-1031C多态进行基因分型,并采用酶联免疫吸附实验(enzyme-linked immunosorbent assay,ELISA)法测定其血清浓度.结果 -1031T/C多态的基因型分布及其等位基因频率在两组间相比差异均无统计学意义(P>0.05).但在男性不稳定性心绞痛患者中,其CC、TC和TT基因型分布与对照组相比有统计学意义(P=0.032),男性CC+TC携带者,不稳定性心绞痛的发病危险是TT携带者的1.66倍(95%CI:1.040～2.659).其等位基因频率在两亚组间相比差异无统计学意义(P>0.05).不稳定性心绞痛组的血清TNF-α浓度明显高于对照组(P=0.028,尤其男性亚组P=0.013),TC基因型的血清TNF-α浓度高于其他基因型,但差异无统计学意义(P>0.05).结论 TNF-α基因启动子区域的-1031T/C多态可能与男性不稳定性心绞痛的发生相关,尤其是男性C等位基因携带者.     

血压正常的2型糖尿病患者24h动态血压与血清胱抑素C相关性研究

目的:探讨血压正常的2型糖尿病(T2DM)患者24 h动态血压与血清胱抑素C(Cys C)的相关性。方法:入选符合纳入标准的T2DM患者82例,据血清Cys C水平将患者分为对照组(Cys C<1.25 mg/L,共42例)和高Cys C组(Cys C≥1.25 mg/L,共40例),所有患者均进行24 h动态血压监测(ABPM)。结果:高Cys C组患者在24 h收缩压(24hSBP)、白天收缩压(dSBP)、夜间收缩压(nSBP)、24 h平均脉压(24hmPP)、白天平均脉压(dmPP)、夜间平均脉压(nmPP)、夜间收缩压最低均值、起床前2 h收缩压均值及起床后2 h收缩压均值与对照组比较,差异均有统计学意义(P<0.05);而在24hDBP、dDBP、nDBP、夜间舒张压最低均值、起床前2 h舒张压均值及起床后2 h舒张压均值与对照组比较,差异均无统计学意义(P>0.05)。对Cys C作Pearson相关分析显示,Cys C与24hSBP、dSBP、nSBP、24hmPP、dmPP、nmPP、夜间收缩压最低均值、起床前2 h收缩压均值及起床后2 h收缩压均值呈正相关(P<0.05),但与24hDBP、dDBP、nDBP、夜间舒张压最低均值、起床前2 h舒张压均值及起床后2 h舒张压均值无相关(P>0.05)。结论:血压正常的T2DM患者中,其收缩压及平均脉压可能与DN有一定相关性。     

Variability of office, 24-hour ambulatory, and self-monitored blood pressure measurements

Background

The diagnosis of hypertension is difficult when faced with several different blood pressure measurements in an individual. Using the average of several office measurements is recommended, although considerable uncertainty remains. Twenty-four-hour ambulatory monitoring is often considered the gold standard, but self-monitoring of blood pressure has been proposed as a superior method.

Aim

Determination of within-individual variability of blood pressure measured in the office, by ambulatory monitoring, and by a week of self-monitoring.

Design of study

Retrospective analysis of a clinical trial of 163 subjects.

Method

Within-patient variability of office and ambulatory blood pressure was determined from measurements at 0 and 6 weeks. Subjects had performed self-monitoring of blood pressure twice each morning and evening, for at least 6 weeks; variability was determined from the means of week 1 and week 6.

Results

The within-individual coefficients of variation (CVs) for systolic blood pressure were: office, 8.6%; ambulatory, 5.5%; self, 4.2%. Equivalent values for diastolic blood pressure were 8.6%, 4.9%, and 3.9%. CVs tended to be lower with longer self-monitoring duration, and higher with longer intervals between self-monitoring.

Conclusion

Office blood pressure is impractical for precise assessment, as 10–13 measurements are required to give the accuracy required for rational titration of antihypertensive drugs. Twenty-four-hour ambulatory monitoring is better than a single office measurement, but considerable uncertainty remains around the estimate. A week of self-monitoring appears to be the most accurate method of measuring blood pressure, but remains imperfect. Further research may identify superior self-monitoring schedules. Given the inherent accuracy in blood pressure measurement, the importance of considering overall cardiovascular risk is emphasised.     

Susceptible locus for obese type 2 diabetes mellitus in the 5'-flanking region of the tumor necrosis factor-alpha gene

We have identified three novel polymorphisms in the promoter/enhancer region of the tumor necrosis factor (TNF)-alpha gene. In this study we investigated the role of the polymorphisms in predisposition to Type 2 diabetes. The allele frequency of C-->T substitution at -857 tended to be higher in obese patients with diabetes than in lean subjects with normal glucose tolerance (0280 vs. 0.190). This tendency was due to a significantly higher ratio of -857T homozygotes in the obese patients with diabetes (15%) than in lean subjects with normal glucose tolerance (4%). There was no significant association between polymorphisms at positions -863 or -1,013, and diabetes. The homozygous -857T allele may be associated with genetic susceptibility to type 2 diabetes in obese subjects.     

神经源分化因子基因多态性与2型糖尿病的关联性研究

目的　探讨神经源分化因子 (neurogenic differentiation factor 1,Neuro D)基因多态性与 2型糖尿病发生的关联性。方法　运用错配聚合酶链反应 -限制性片段长度多态性方法检测了中国湖北地区汉族 32 4例 2型糖尿病 (其中以发病年龄 40岁为界 ,分为早发及晚发两组 )及 12 4名正常对照者 ,Neuro D基因第 45位密码子碱基变异 (GCC→ ACC)。结果　 Neuro D基因在所测人群中未发现有纯合变异者。在早发 2型糖尿病组 ,其 AT基因型频率为 2 6 .8% ,与正常对照组 (10 .5 % )及晚发 2型糖尿病组 (11.6 % )比较 ,差异有显著性 (分别为χ2 =7.85 ,P=0 .0 0 5 ;χ2 =8.81,P=0 .0 0 3) ;Thr45等位基因频率在早发 2型糖尿病组及正常对照组、晚发 2型糖尿病组分别为 13.4%、5 .2 %和 5 .8% ,差异亦有显著性 (χ2 =7.15 ,P=0 .0 0 8;χ2 =8.13,P=0 .0 0 4) ;晚发 2型糖尿病组与正常对照组比较 ,Ala45 Thr基因型频率 (11.6 % vs10 .5 % ,P>0 .0 5 )及等位基因频率 (5 .8% vs 5 .2 % ,P>0 .0 5 )差异不明显 ,Thr45等位基因与早发 2型糖尿病发生相关 (OR=2 .5 2 ,95 % CI:1.42～ 4.49) ;基因型为 AT型的 2型糖尿病患者其空腹血浆 C肽水平较 AA型患者低 ,差异有显著性 (P<0 .0 5 )。结论　 Neuro D基因多态性与早发 2型糖尿     

Analysis of tumor necrosis factor-alpha promoter polymorphism in type 1 diabetes: HLA-B and -DRB1 alleles are primarily associated with the disease in Japanese

Polymorphisms in the 5'-flanking region of the tumor necrosis factor (TNF)-alpha gene were examined to study the genetic background of type 1 diabetes in Japanese. Five different biallelic polymorphisms were examined in 136 type 1 diabetic patients and 300 control subjects. The frequencies of individuals carrying TNF-alpha-857T allele (designated as TNFP-D allele) or -863A/-1,031C allele (designated as TNFP-B allele) were significantly increased in the patients as compared with the controls. Since these TNF-alpha alleles are in linkage disequilibria with certain DRB1 and HLA-B alleles, two-locus analyses were carried out. The TNFP-D allele did not increase the risk in either the presence or absence of the DRB1*0405 or HLA-B54 allele, while the DRB1*0405 and HLA-B54 alleles per se could confer susceptibility in both the TNFP-D allele-positive and -negative populations. Moreover, an odds ratio was remarkably elevated in the population carrying both DRB1*0405 and HLA-B54. Similarly, the TNFP-B allele did not show significant association with the disease in either the HLA-B61-positive or -negative population, while the HLA-B61 allele could significantly increase the risk in the TNFP-B allele-positive population. These data suggest that the associations of TNFP-D and -B alleles may be secondary to their linkage disequilibria with the susceptible HLA class I and class II alleles. Because HLA-B and DRB1 genes were independently associated, both of these genes may be contributed primarily to the pathogenesis of type 1 diabetes in Japanese.     

Association of tumor necrosis factor-alpha and interleukin-10 gene polymorphisms in Iranian patients with pre-eclampsia

PROBLEM: Considering that certain cytokines may change during pre-eclampsia (PE), because of functional polymorphisms in their genes, our purpose was to determine the association between tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) gene polymorphisms and development of PE. METHOD OF STUDY: The genetic polymorphisms of TNF-alpha and IL-10 was studied by polymerase chain reaction-sequence specific primers in the DNA of peripheral blood cell from 160 patients with PE and 100 healthy pregnant women. RESULTS: We found a significant difference between TNF-alpha A allele (-308) and G allele (-238) in PE patients compared with those of the control groups. A significantly higher C/C genotype frequency of IL-10 (-592 and -819) was observed in the PE patients than in the control groups. In addition, the frequencies of three common IL-10 haplotypes (GCC, ACC, and ATA) did not show any significant difference between the study groups. CONCLUSION: These findings would support the concept of contribution of TNF-alpha and IL-10 gene polymorphisms in the pathogenesis of PE in our population.     

Tumor necrosis factor-alpha gene promoter -308G/A and -238G/A polymorphisms in Mexican patients with type 2 diabetes mellitus

The association between some Tumor necrosis factor-alpha (TNF-α) promoter polymorphisms and Type 2 diabetes mellitus (T2DM) remains controversial. Ethnic differences may play a role in these conflicting results. The aim of this study was to investigate the association between -308G/A and -238G/A polymorphisms located in the promoter region of the TNF-α gene and T2DM in Mexican mestizo patients. Nine hundred four individuals (259 patients with T2DM and 645~controls) were genotyped for the -308G/A and -238G/A polymorphisms by PCR--RFLP. We found that the -238A allele increased the risk of developing T2DM in Mexican patients (OR=1.57, 95% CI: 1.07-2.29; p=0.018). Moreover, we found that the frequency of the GA haplotype (created by the -308G and -238A alleles) was significantly increased in patients with T2DM when compared with controls (OR =1.56, 95% CI: 1.05-2.31; p=0.026). Our results suggest that the -238G/A polymorphism and a specific haplotype (GA) are genetic risk factors for the development of T2DM in Mexican population.     

Association of FADS2 rs174575 gene polymorphism and insulin resistance in type 2 diabetes mellitus

BackgroundMany risk factors contribute to the pathogenesis of diabetes. Gene and lifestyle factors are considered to be the major contributors. A dietary pattern is attributed to be one of the lifestyle risk factors favoring diabetes. The present study aims to find an association between fatty acid desaturase (FADS) gene polymorphism and glycemic profile in type 2 diabetes mellitus (T2DM).MethodologyA total of 429 subjects were included in the study on the basis of inclusion and exclusion criteria, of which 213 and 216 subjects were diabetic and control, respectively. Body mass index was calculated. Fasting plasma glucose, glycated hemoglobin (HbA1c) and insulin were measured using commercially available kits. rs174575 of FADS2 was selected based on previous publications and identified using the dbSNP database. To compare the biochemical parameters with the genotype, the following three models were used: additive model (CC vs CG vs GG), dominant model (CC + CG vs GG), and recessive model (CC vs CG + GG).Results and DiscussionFBS, HbA1c, insulin, HOMA-IR, and HOMA-B exhibited a high and statistically significant difference between subjects and controls. The three models exhibited a statistically significant difference between FBS, HOMA-IR, and HOMA- B (p<0.05).ConclusionThe distribution of rs174575 genotype differed significantly between the subjects and controls in the present study. The study revealed that genetic variation in FADS2 is an additional facet to consider while studying the risk factors of T2DM.     

Significant association of a single nucleotide polymorphism in the tumor necrosis factor-alpha (TNF-α) gene promoter with human narcolepsy

Narcolepsy is a sleep disorder in which multiple factors, including environmental and genetic factors, are involved. A genetic factor strongly associated with the disorder has been found in the human leukocyte antigen (HLA) class II region: the haplotype, DRB1*1501-DQB1*0602, predisposes to narcolepsy. No susceptibility genes other than the HLA-haplotype have been found. In this paper, we performed an association study of the tumor necrosis factor-alpha (TNF-alpha) gene located in the HLA class III region with human narcolepsy, in which we examined the known single-nucleotide polymorphisms (SNPs) in the promoter region in 49 narcoleptic patients, who were all positive for DRBI*1501, and 111 healthy control individuals. The results indicated that the frequency of the genotype at position -857 (-857SNP) was significantly different between the patients and controls, and the allele frequencies of 857SNP revealed that the frequency of -857T was significantly increased in the patients as compared with that in the controls (P=0.0068). In addition, haplotypes presumed from HLA-DRB1, -857SNP and HLA-B loci suggested that -857T was mainly associated with DRB1 alleles other than DRB1*1501: the significant increase in frequency of -857T in the patients was not caused by allelic association with DRB1*1501. Therefore, it is conceivable that the TNF-alpha with 857T was associated with narcolepsy independently of the strong association of DRB1*1501 with the disorder. Altogether, the data presented here lead us to propose that TNF-alpha could be a new susceptibility gene in human narcolepsy.     

Association and interaction of the TNF-alpha gene with other pro- and anti-inflammatory cytokine genes and HLA genes in patients with type 1 diabetes from North India

Type 1 diabetes (T1D) is a multifactorial autoimmune disorder where major histocompatibility complex (MHC) genes and the insulin-linked polymorphic region have been shown to play major roles. We report here an integrated effect of tumor necrosis factor (TNF) alpha with other cytokine genes. The TNF-alpha-308 GA and AA (high secretor) polymorphisms were significantly increased in the patients with T1D (n = 235) [P < 7 x 10(-6), odds ratio (OR) = 3.04, 95% confidence interval (CI) = 1.8-5.3] compared with the controls (n= 128). The variants of interferon-gamma (IFN-gamma) (A(+874)T), interleukin (IL)-6 (G(-174)C), IL-10 (A(-1082)G, T(-819)C, C(-592)A) and transforming growth factor (TGF) beta1 (T(cdn10)C, G(cdn25)C) did not show a significant difference between patients and controls. However, simultaneous presence of TNF-alpha-308 GA+AA along with both high and low secretor genotypes of IFN-gamma (P < 0.003) was significantly increased in patients. Simultaneous presence of TNF-alpha-308 GA + AA along with high secretor genotypes of IL-6 (P < 0.0001, OR = 2.61, 95% CI = 1.5-4.56), IL-10 (P < 0.0001, OR = 4.26, 95% CI = 1.9-10.1) and TGF-beta1 (P < 0.00004, OR = 2.8, 95% CI = 1.6-4.86) was also significantly increased in patients with T1D. Low secretor genotype of TNF-alpha-308 GG along with low secretor genotypes of IFN-gamma (P < 0.001, OR = 0.465, 95% CI = 0.28-0.77), high secretor genotypes of IL-6 (P < 0.000004, OR = 0.76, 95% CI = 0.227-0.621) and TGF-beta1 (P < 0.000006, OR = 0.336, 95% CI = 0.198-0.568) was protective. The TNF-alpha-308 G allele was in linkage disequilibrium (LD) with the human leukocyte antigen (HLA)-B*0801-DRB1*0301 haplotype, while TNF-alpha-308 A allele was in LD with the HLA-B*5001-DRB1*0301 and B*5801-DRB1*0301 haplotypes, suggesting that the effect of TNF-alpha -308 A allele is not because of its being in LD with any HLA alleles, but because of its functional role and its integrated effect with other cytokines.     

锰超氧化物歧化酶基因Ala(-9)Val多态性与2型糖尿病视网膜病变的相关性

目的 探讨锰超氧化物歧化酶(manganese superoxide dismutase,Mn-SOD)基因Ala(-9)Val多态性与2型糖尿病视网膜病变发生的关联性.方法 应用PCR-直接测序方法检测了中国湖北地区汉族264例2型糖尿病患者和198名正常对照者的Mn-SOD基因Ala(-9)Val多态性(GCT→GTT).结果 (1)2型糖尿病组与正常对照组比较,VV基因型频率(72.7%vs 67.2%,P>0.05)与V等位基因频率(76.1%vs71.0%,P>0.05)差异无统计学意义.(2)在2型糖尿病者中,有糖尿病视网膜病变(diabetic retinopathy,DR)组 VV基因型频率为79.2%,与无糖尿病视网膜病变(non-diabetic retinopathy,NDR)组(66.9%)比较,差异有统计学意义(x2=5.015,P=0.025);V等位基因频率在DR组为82.4%,NDR组为70.5%,差异亦有统计学意义(x2=10.253,P=0.001);NDR组与正常对照组比较,VV基因型频率(66.9%vs67.2%,P>0.05)及V等位基因频率(70.5%vs 71.0%,P>0.05)差异无统计学意义,V等位基因与2型糖尿病视网膜病发生相关(OR=1.96,95%CI:1.29-2.97).(3)基因型为VV型的2型糖尿病患者其Nn-SOD水平较AA型、AV型患者低,差异有统计学意义(P=0.025),其总超氧化物歧化酶有增加趋势,但差异无统计学意义(P>0.05).结论 Mn-SOD基因Ala(-9)Val多态性与2型糖尿病发病无关,但可能参与了2型糖尿病视网膜病变的发生、发展过程.     

白细胞介素6受体基因单核苷酸多态性与2型糖尿病的关联性

目的探讨甘肃地区汉族人中白细胞介素6受体基因（interleukin 6 receptor gene，IL6R）启动子-183（G→A）和第9外显子D358A的变异与2型糖尿病（type 2 diabetes mellitus，T2DM）的关联。方法随机选取无亲缘关系甘肃地区汉族人183名，其中T2DM患者87例、正常对照96名，应用聚合酶链反应-限制性片段长度多态性（polymerase chain reaction-restriction fragment length polymorphism，PCR-RFLP）方法进行-183（G→A）和D358A变异的检测。结果正常对照组D358A的3种基因型频率和等位基因频率分别为AA31．2％、AC41．7％、CC27．1％、A52．1％、C47．9％，2型糖尿病组相应为AA44．8％、AC41．4％、CC13．8％、A65．5％、C34．5％，正常对照组CC基因型频率和C等位基因频率高于2型糖尿病组（χ^2=4．900，P〈0．05；χ^2=6．784，P〈0．01）。-183（G→A）3种基因型频率和等位基因频率差异无统计学意义。结论提示该基因D358A多态可能与中国人2型糖尿病关联。     

The effect of melatonin on circadian blood pressure in patients with type 2 diabetes and essential hypertension

Introduction

The aim of this study was to evaluate the effect of melatonin on blood pressure in patients with essential hypertension receiving medical treatment and with type 2 diabetes in good metabolic control.

Material and methods

The study lasted 8 weeks. Patients were equipped with a 24-hour ambulatory blood pressure monitor and took melatonin (3 mg a day in the evening) for 4 weeks. The patients were divided into four groups: group 1 (n = 32) including dippers, group 2 (n = 34) non-dippers treated with melatonin; and two control groups: group 3 (n = 28) including dippers and group 4 (n = 30) non-dippers treated without melatonin. After 4 weeks patients took melatonin for the next 4 weeks (5 mg a day). In each visit were analyzed: systolic, diastolic and mean blood pressure in both day and night time.

Results

We observed that 29.5% non-dippers (n = 10) treated with melatonin in a dose of 3 mg/day achieved features of dippers compared to control group (p < 0.05). Five mg of melatonin per day restored normal diurnal blood pressure rhythm in 32.4% non-dippers (n = 11, p < 0.05). In non-dippers treated with melatonin significant decreases of diastolic, systolic and mean night blood pressure values (p < 0.05) were observed.

Conclusions

More than 30% of non-dippers with type 2 diabetes treated with melatonin were restored to the normal circadian rhythm of blood pressure. The effect of melatonin in both doses (3 mg and 5 mg) was significant for non-dippers only and included nocturnal systolic, diastolic and mean arterial pressure.     

Association of a polymorphism of the transforming growth factor-beta1 gene with blood pressure in Japanese individuals

Transforming growth factor-β1 (TGF-β1) is an important regulator of blood pressure (BP) and vascular remodeling, and thus may contribute to the pathogenesis of hypertension. A T→C transition at nucleotide 869 of the TGF-β1 gene results in a Leu→Pro substitution at amino acid 10 of the signal peptide. We have now examined the possible association of the 869T→C polymorphism of the TGF-β1 gene with BP and the prevalence of hypertension in 2241 community-dwelling Japanese individuals (1126 men and 1115 women). TGF-β1 genotype was determined by an allele-specific polymerase chain reaction method. For women, both systolic and diastolic BP was significantly higher in individuals with the CC genotype than in those with the TT or TC genotype. No significant association between TGF-β1 genotype and BP was detected in men. The frequency of the CC genotype was significantly higher in women with hypertension than in those with normal BP. These results suggest that the TGF-β1 gene at chromosome 19q13.1 may be a candidate susceptibility locus for hypertension in Japanese women. Received: January 30, 2002 / Accepted: February 20, 2002     

PPP1R3基因3′端非翻译区5 bp缺失/插入多态性与2型糖尿病相关性研究

目的　研究 1型蛋白磷酸酶骨骼肌特异糖原靶向调节亚单位 (PPP1R3)基因 3′-非翻译区 5 bp缺失 /插入 (deletion/insertion,D/I)多态性与 2型糖尿病 (type 2 diabetes,T2 DM)的相关性。方法　选取安徽省合肥地区汉族 T2 DM患者 2 6 8例 ,正常对照 10 6名 ,用聚合酶链反应扩增片段长度多态性技术进行基因型测定。结果　 (1) PPP1R3基因 3′-非翻译区 5 bp D/I多态性的基因型及等位基因频率在 T2 DM与正常对照组间分布差异无显著性 (P>0 .0 5 )。(2 ) T2 DM或正常对照组中不同基因型间发病年龄、病程、空腹血糖、餐后 2 h血糖、空腹胰岛素、胰岛素敏感指数、体重指数、腰臀围比、收缩压、舒张压差异均无显著性 (P>0 .0 5 )。(3) PPP1R3基因 3′-非翻译区 5 bp D/I多态性频率与日本人群和加拿大人群相近。明显低于 Pima印第安人、瑞典的白人。结论　 PPP1R3基因 3′-非翻译区 5 bp D/I多态性与安徽省合肥地区 2型糖尿病发病无明显关联 ,具有明显的种族差异。