제2형 당뇨병 환자에서 Apo E 및 ACE 유전자 다형성이 당뇨병성 신증에 미치는 영향
Apolipoprotein E and ACE genetic polymorphism and nephropathy in type 2 diabetic patients
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목적 : 제2형 당뇨병 환자를 대상으로 하여 Apo E 유전자 및 ACE 유전자 다형성을 조사함으로써 당뇨병에 동반된 신증에 미치는 영향을 알아보았다.방법 : 영동세브란스병원 내분비-대사내과 외래를 다니는 제2형 당뇨병 환자 중 유병기간 8년 이상인 118명을 대상으로 하였다. Apo E 유전자 및 ACE 유전자형에 따라 분류하고 임상적 및 생화학적 특성을 조사하여 당뇨병성 신증의 유무에 따른 차이점과 상호 연관성을 평가하였다.결과 : Apo E 아형에 따른 혈청 지질은 E2군에서 중성지방이 높았으며 E4군이 총 콜레스테롤 및 LDL 콜레스테롤이 높았다. Apo E 아형에 따른 당뇨병성 신증의 빈도는 E2군이 높았고, ACE 아형에 따른 임상적 특성 및 신증의 유의한 차이는 없었다. 당뇨병성 신증에 대해 Apo E 유전자형 및 ACE 유전자형간의 상호 작용은 없었다.
Abstract
Background : The aim of this study was to investigate the association between apo E and ACE genetic polymorphism and diabetic nephropathy. Methods : One hundred eighteen patients with type 2 diabetes who had a duration of diabetes longer than 8 years were divided into the three apo E groups (E2, E3, E4) and three ACE groups (II, ID, DD). Plasma levels of lipids were measured. The frequency of diabetic nephropathy and clinical and biochemical characteristics were compared among the Apo E and ACE genotype groups. Results : The frequency of overt nephropathy was significantly greater in apo E2 patients with diabetes (46.7%) than apo E3 (16.7%) or apo E4 patients (10.5%). Logistical regression analysis showed that odds ratio of apo E2 and apo E4 genotypes for the presence of overt nephropathy were 4.779 (p<0.01) and 0.643 (p=0.583), respectively. Plasma TG levels were significantly greater in apo E2 patients. This study did not show an association between ACE gene polymorphism and diabetic nephropathy, and no interaction between Apo E and ACE gene polymorphism. Conclusion : Apo E2 is a prognostic risk factor for diabetic nephropathy in Korean type 2 diabetes. TG may have an important role of diabetic nephropathy. There were not synergistic effect between Apo E and ACE gene polymorphism in diabetic nephropathy.(Korean J Med 68:511-518, 2005)
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