The Association Between Ace Gene Insertion/deletion Polymorphism And Carotid Intima-media Thickness In Hans Chinese Type 2 Diabetic Patients From Chenzhou

ObjectiveTo determine the angiotensin-converting enzyme(ACE) insertion/deletion(I/D) polymorphism in Han ethnic patients with type 2 diabetes in Chenzhou area of Hunan province, and to assess the association between this polymorphism and blood pressure as well as diabetic nephropathy(DN), diabetic retinopathy(DR), and carotid intima-media thickness(CIMT).Method168 consecutive type 2 diabetic patients with a diabetes duration of more than 2 years were enrolled and the patients were categorized depending on whether there is hypertension(HT), DN, and DR, PCR method to define their ACE genotype, high-resolution color ultrasonograph to measure the CIMT. glycolated hemoglobin A1c (GH bA1c), urine protein and lipids were measured. Compare the genotype distribution according to the presence or absence of HT, DN, DR and carotid intima thickening in these patients. Analysis the risk factors of carotid artery intima thickening with Logistic regression analysis.Result(1)ACE genotype distribution in patients of this group are as follows: DD,21.4%;ID,38.1%;II,40.5%.(2)The range of CIMT is from 0.41 to 1.12 mm. The patients with DD genotype have the biggest average CIMT, 0.84±0.16mm; the patients with II genotype have the smallest average CIMT, 0.65±0.10mm; in the patients with DI genotype, CIMT is 0.72±0.11mm. By the one-way ANOVA analysis, among the three genotypes, CIMT has statistics difference (P=0.001). (3)In the patients with DD genotype, DN patients account for 33.3%, in the patients with ID genotype, DN patients account for 34.4%, in the patients with II genotype, DN patients account for 11.8%. Among the patients with three kinds of genotype, the proportion of DN complication is different significantly (P=0.001). The patients with DD genotype have higher relative risk to have DN complication (odds ratio, 2.83, DD versus II; 95% CI: 1.28-6.29). (4)In the patients with DD genotype, HT patients account for 47.2%, in the patients with ID genotype, HT patients account for 12.5%, in the patients with II genotype, HT patients account for 10.3%. Among the patients with three kinds of genotype, the proportion of HT complication is different significantly (P=0.005). The patients with DD genotype have higher relative risk to have HT complication (odds ratio, 4.26, DD versus II; 95% CI: 2.31-7.49). (5)Logistic regression analysis showed that the risk factors of carotid intima-media thickenning were feminine gender, ACE-DD genotype, DN and advanced age .Conclusion(1)D allele is associated with macrovascular complications such as hypertension and carotid intima-media thickenning in the patients with type 2 diabetes mellitus(type 2-DM)in Chenzhou area;(2)D allele is associated with microvascular complications such as nephropathy in in the patients with type 2 DM in Chenzhou area;(3)The risk factors of carotid intima-media thickening were the female gender,ACE-DD genotype,DN and advanced age.