| Objective: ACE is the key enzyme of RAAS. ACE gene contains the insertion and deletion(I/D) polymorphism, which includes DD?ID?II genotypes. ACE genotype decides the level of serum ACE. The objective of this study is to investigate the association between the polymorphisms of ACE genes and the decline of renal function in Chinese elderly people.Methods: 366 elderly patients(older than 60 years of age) were enrolled from geriatrics department of Ruijin Hospital in 2006. The medical history(hypertension and diabetes) was collected; The height, weight were measured;Liver function,fast glucose,serum lipid and renal function were assayed.Polymerase chain reaction(PCR) was used to characterize ACE genotypes(ID,II,DD). All the patients were followed up in 2009 and 2012 respectively. We use the creatinine clearance calculated by CG equation to evaluation the renal function. The study was divided into two parts.1. The cross sectional study: The data of 2009 was used. This study enrolled 164 cases.Exclusion criteria included the diabetes; unable to get the Ccr; renal function damage without hypertension. All of them were divided into three groups according to Ccr and hypertension history: normal group(N), hypertension group(EH: Ccr?60ml/min) and hypertension with renal damage group(HN: Ccr<60ml/min).2. The prospective study: The data of 2006 was used as the baseline, the patients were followed up 6 years later in 2012. 152 patients was enrolled in this study after excluding those dead and those could not be followed up. All of them were divided into two groups by ACE genotypes, the group DD+ID and the group II.Results:1. The cross sectional study:1.1 There was significant difference among the three groups at age, weight, BUN and SCR?Ccr(P<0.05). Age, BUN and SCR of group HN are generally higher than the other groups. Weight?Ccr of group HN was generally less than the other groups. In addition, there was no significant difference between group N and group EH(P>0.05). The SBP of group HN and EH was higher than that of group N(P <0.05). There was no difference as to FBG?blood lipids and DBP among the three groups.1.2 The expected frequencies of the ACE genotypes were under the assumption of the Hardy-Weinberg equilibrium in each groups(P>0.05).1.3 Chi-square test demonstrated that the distribution of ACE DD was higher in group HN than that of other groups(P<0.05); There was no significant difference between group N and group EH in the distribution of ACE genotypes. There was no significant difference of the distribution of ACE DD between group N and group EH+HN(>0.05). Also, there was no significant difference among the three groups as to ACE ID and ACE II genotype(P>0.05).2. The prospective study:2.1 There was significant change in weight, blood pressure, FBG, and Ccr after 6 year's follow-up(P<0.05). The weight, SBP, DBP, Ccr were on a declining trend while the FBG was on a rising trend. There was no significant difference in blood lipid, BUN, SCR, the incidence of diabetes and hypertension after 6 year's follow-up(P>0.05). Neither on the baseline nor at the end of the follow-up, there was no significant difference between the group DD+ID and group II as to blood lipid, SBP, DBP,the incidence of diabetes and hypertension(P >0.05).2.2 The expected frequencies of the ACE genotypes were under the assumption of the Hardy-Weinberg equilibrium in each groups(P>0.05).2.3 The decrease of Ccr in group DD+ID is more than that in group II. There is significant difference between the two groups(P<0.05).Conclusion:1. ACE DD genotype is the risk factor of renal damage in the patients with hypertension. 2. The D allele of ACE gene is associated with the decrease of kidney function in Chinese elderly people. |
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