Korean Journal of Nephrology 1998;17(1):71-79.

한국의 당뇨병성 신증 환자에서 안지오텐신전환효소 유전자형에 대한 연구

윤종우 , 조상경 , 차대룡 , 조원용 , 김형규 , 권영주 , 표희정 , 김창수 , 박상은 , 문창훈 , 서상열 , 오경식 ,정태시 , 민현조

Abstract

Diabetic nephropathy is an important cause of end-stage renal disease in Korea and associated with morbidity and mortality of diabetes mellitus patients. Reninangiotensin system plays an impor- tant role in pathogenetic mechanism of renal injury associated with angiotensin II. Its activity is controlled by angiotensin-converting enzyme(ACE) activity. Plasma and tissue ACE levels can be under the control of an Insertion/Deletion(I/D) polymo- rphism of the ACE gene, and this polymorphism has shown to be associated with the risk of various complications of diabetes mellitus. So we evaluate the distribution of ACE gene polymorphism in various conditions of diabetes mellitus, diabetic nephropathy, end stage renal disease(ESRD), other microvascular complications such as diabetic neuropathy and diabetic retinopathy, and ischemic heart disease or left ventricular hypertrophy, ACE genotype was determined in 171 diabetes mellitus patients(64 without nephropathy, 34 with nephropathy, 73 ESRD) and 120 non-diabetic controls by DNA PCR. The results were as follow. 1) Patients population consist of 171 diabetes mellitus and male to female ratio was 81:90, mean age 55.2±14.1 years old. 120 nondiabetic controls were male to female ratio 62:58, mean age 46.1±15.1. The age and sex distritution in control and patient group was not significantly different. 2) ACE genotypes in whole population were 29.9% DD genotype, 47.8% ID genotype, 22.3% II genotype. ID genotype was most frequently encoun- tered, and DD genotype was found frequently in diabetic nephropathy group compare to non-nephro- pathy group(41.1% vs. 17.2%, P<0.05). 3) Microvascular complications were not significantly associated with ACE gene polymorphism. 4) The genotype distribution in diabetes mellitus patients according to the prevalance of LVH or ischemic heart disease showed no significant asso- ciation with ACE genotype. From the above results, we concluded that ACE gene polymorphism was important in the progression of diabetic nephropathy, and DD genotype was considered to be a risk factor of disease progression.