Abstract
Aims:This study aims to investigate the association between renin-angiotensin system gene polymorphism and diabetic retinopathy (DR) in Chinese patients with type 2 diabetes.Methods:We consecutively included 1491 patients for the assessment of ACE I/D and AGT M/T gene polymorphisms in 345 DR cases and 1146 patients without retinopathy (DNR). Albuminuria was defined by urine albumin creatinine ratio and albumin excretion rate.Results:Compared with the NDR patients, the DR cases displayed a higher proportion of diabetic nephropathy (32.68% vs. 6.52%, χ2 = 150.713, p < 0.001). The DR cases and DNR individuals did not differ in the frequency of genotypes and alleles of ACE I/D and AGT M/T (all p > 0.05). Intriguingly, DR patients with obesity showed higher frequency of DD (χ2 = 4.181, p = 0.041), but no significant difference exists in the other stratified BMI and hypertension analyses (all p > 0.05). Binary logistic regression displays that the association of the ACE and AGT gene polymorphisms in DR patients is not significant after adjusting for confounding covariates in all the comparisons.Conclusions:The ACE and AGT gene polymorphisms are not associated with the progress of diabetes developing into retinopathy in Chinese patients with type 2 diabetes. However, more investigations are needed to further prove the association.
Highlights
Diabetic retinopathy (DR) is one of the most devastating microvascular complications of diabetes mellitus[1] and remains a major cause of visual morbidity in developed and developing countries.[2,3] Epidemiological studies have shown that DR exists in almost all individuals with longstanding type 1 diabetes mellitus (T1DM), and approximately 60% of patients with type 2 diabetes mellitus (T2DM) develop retinopathy.[4]
Successful genotyping for Concordance between DR and diabetic nephropathy defined by albumin-to-creatinine ratio (ACR)/albumin excretion rate (AER)
In a total of 1491 T2DM patients, we found that no significant difference existed between DR and diabetic non-retinopathy (DNR) patients regarding angiotensin-converting enzyme (ACE) or AGT genotype or allele, and our negative findings are consistent with previous studies.[1,11,28]
Summary
Diabetic retinopathy (DR) is one of the most devastating microvascular complications of diabetes mellitus[1] and remains a major cause of visual morbidity in developed and developing countries.[2,3] Epidemiological studies have shown that DR exists in almost all individuals with longstanding type 1 diabetes mellitus (T1DM), and approximately 60% of patients with type 2 diabetes mellitus (T2DM) develop retinopathy.[4]. RAS is fundamental to blood pressure regulation; as such, each component is potentially involved in the etiology of the polygenic disorder known as primary hypertension.[12] AGT is converted to angiotensin I by renin, and subsequently into angiotensin II by ACE.[13] ACE plays an important role in the regulation of systemic and renal vascular circulation by converting angiotensin I into vasoconstrictor molecule angiotensin II.[14] Higher levels of renin activity and ACE activity during the course of diabetes result in an excess of angiotensin II in the eye, abnormally constricted retinal arterioles, elevated local intravascular blood pressure, reduced retinal blood flow, increased permeability of retinal blood vessels, and ocular neovascularization.[15] Interestingly, the ACE gene intron 16 insertion/deletion (I/D) polymorphism accounts for about one-half of the phenotypic variance in plasma ACE levels.[16]. We have shown an association of diabetic glomerulosclerosis with immunoreactivity of ACE and AGT.[20] Here we report that the ACE and AGT gene polymorphisms might not have a significant effect on DR in a group of Chinese T2DM patients
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