말기 신부전 환자에서 안지오텐신 전환효소 유전자형에 대한 연구 (Angiotensin Converting Enzyme Polymorphism in Patients with End Stage Renal Disease)
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영문초록
An Insertion/deletion polymorphism in angiotensin converting enzyme gene has been considered the important regulator of ACE activity in plasma and tissue. The deletion allele of this gene is associated with higher ACE activity, which ultimately increased angiotensin Ⅱ formation. It is possible that alteration of ACE polymorphism might be contribute to development of end stage renal disease and cardiovascular disease where RAS system is implicated in disease process. This study determined the distribution of ACE genotype in 122 end stage renal disease patients and in a group of 101 healthy controls. Also we evaluated the difference of allele frequency in the hemodialysis patients with or without cardiovascular disease. ACE genotype was determined by polymerase chain reaction technique from the PBMC leukocytes of the patients. The results were as follows; 1)Patients population consisted of 122 hemodialysis patients and male to female ratio was 66:56, mean age was 54.3±12.8 years old. Mean duration of dialysis treatment was 52.5±37.5 months and the underlying disease of ESRD were diabetic nephropathy in 78 cases, chronic glomerulonephritis in 29 cases, hypertension in 8 cases, other disease in 7 cases. 2)In the contol patients, male to female ratio was 52:49, mean age was 46.1±15.1 years old. The age and sex distribution between ESRD and control group was not significantly different. 3)Of the total hemodialysis patients, 26.2% showed the Ⅱ genotype, 35.2% of ID genotype and 38.6% of DD genotype. In the contol group, the frequency of each genotype was 20.8% of Ⅱ, 55.4% of ID and 23.8% of DD genotype. The frequency of DD genotype was significantly higher in ESRD group than control group(p<0.05). 4)In the ESRD patients, 72 patients(59%) had the LVH and 23 patients(18%) had the ischemic heart disease. The genotype distribution in ESRD patients according to the presence of LVH or ischemic heart disease did not show any significant difference. The frequency of each genotype in the patients with LVH showed 22.2%(Ⅱ), 43.1%(ID), 34.7%(DD), and 32.8%(Ⅱ), 37.5%(ID), 29.7%(DD) in the patients without LV ¡ªDae Ryong Cha, et al.:Angiotensin Converting Enzyme Polymorphism in Patients with End Stage Renal Disease― H. In the aspect of ischemic heart disease, the frequency of ACE genotype was 27.3%(Ⅱ), 45.5% (ID), 27.3%(DD) in the group of ischemic heart disease, compared with the ditribution of 31.5 %(Ⅱ), 40%(ID), 32.6%(DD) in the patients without ischemic heart disease. From the above results, it was concluded that insertion/deletion polymorphism in angiotensin converting enzyme gene, especially DD genotype, may be important in the pathogenesis of progression to end stage renal disease. There was no significant difference in I/D polymorphism according to the presence or absence of cardiovascular complications
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