Diamantopoulos E J, Andreadis E, Kakou M, Vlachonikolis I, Vassilopoulos C, Giannakopoulos N, Tarassi K, Papasteriades C, Nicolaides A, Raptis S
4th Department of Internal Medicine, Medical School, University of Crete, Crete, Greece.
Int Angiol. 2002 Mar;21(1):63-9.
The aim of the present study was to investigate the association of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism with the ultrasonographically evaluated severity and characteristics of carotid artery atherosclerosis in subjects with diabetes mellitus type 2.
We assessed 184 subjects with diabetes mellitus type 2, 75 males and 109 females, mean age 61.4+/-7.7 years. All subjects were receiving oral antidiabetic drugs for glycemic control and were free of cardiovascular events. The ACE genotype was analyzed by the polymerase chain reaction (PCR) technique. The ultrasonographic examination of the carotid arteries was performed in both B-mode imaging and Doppler ultrasound. The common carotid artery intima-media thickness was assessed 15-20 mm proximal to the dilatation of the carotid bulb. The atheromatous lesions were classified according to their echogenic characteristics as predominantly echolucent, mixed and predominantly echogenic with under 30, 30-70 and over 70% of the total plaque area echogenicity, respectively.
From the total cohort 29 (15.8%) subjects had the II, 86 (46.7%) the ID and 69 (37.5%) the DD ACE genotypes. The mean carotid artery diameter stenosis was 37+/-17%, 43+/-19% and 40+/-20% (p=NS) and the intima media thickness was 0.94+/-0.24 mm, 0.97+/-0.20 mm and 0.98+/-0.20 mm (p=NS) in the II, ID and DD subgroups, respectively. When the echogenicity was analyzed according to the ACE I/D polymorphism, 12 subjects (41.4%), 13 (44.8%) and 4 (13.8%) with II genotype had predominantly echogenic, mixed and predominantly echolucent lesions, respectively. The ID genotype diabetics were found to have predominantly echogenic plaques in 41 cases (47.7%), mixed in 30 (34.9%) and predominantly echolucent in 15 cases (17.4%). From the 69 DD subjects 19 (27.5%) had predominantly echogenic plaques, 26 (37.7%) had mixed and 24 (34.8%) had predominantly echolucent lesions. Predominantly echolucent plaques were more frequently encountered among diabetics with the DD genotype (p<0.05), even after correction for demographic characteristics, the main risk factors of atherosclerosis and blood glucose control.
The ACE genotype seems to be associated with the echogenicity of carotid artery atheromatosis but not with the common carotid artery intima media thickness or the degree of internal carotid artery stenosis in subjects with type 2 diabetes mellitus. The DD genotype may be implicated in the increased cardiovascular risk that characterizes echolucent plaques.
本研究旨在探讨血管紧张素转换酶（ACE）插入/缺失（I/D）多态性与2型糖尿病患者经超声评估的颈动脉粥样硬化严重程度及特征之间的关联。
我们评估了184例2型糖尿病患者，其中男性75例，女性109例，平均年龄61.4±7.7岁。所有受试者均接受口服抗糖尿病药物以控制血糖，且无心血管事件。采用聚合酶链反应（PCR）技术分析ACE基因型。对颈动脉进行B型成像和多普勒超声检查。在颈动脉球部扩张近端15 - 20 mm处评估颈总动脉内膜中层厚度。根据动脉粥样硬化病变的回声特征将其分类为主要为无回声、混合回声和主要为高回声，分别占总斑块面积回声的30%以下、30% - 70%和70%以上。
在整个队列中，29例（15.8%）受试者为II型ACE基因型，86例（46.7%）为ID型，69例（37.5%）为DD型。II型、ID型和DD型亚组的平均颈动脉直径狭窄率分别为37±17%、43±19%和40±20%（p =无显著性差异），内膜中层厚度分别为0.94±0.24 mm、0.97±0.20 mm和0.98±0.20 mm（p =无显著性差异）。根据ACE I/D多态性分析回声特征时，II型基因型的12例（41.4%）、13例（44.8%）和4例（13.8%）受试者分别主要有高回声、混合回声和主要无回声病变。ID型基因型糖尿病患者中，41例（47.7%）主要有高回声斑块，30例（34.9%）为混合回声，15例（17.4%）主要为无回声。在69例DD型受试者中，19例（27.5%）主要有高回声斑块，26例（37.7%）为混合回声，24例（34.8%）主要为无回声病变。即使在校正人口统计学特征、动脉粥样硬化主要危险因素和血糖控制后，DD型基因型糖尿病患者中主要无回声斑块更为常见（p<0.05）。
ACE基因型似乎与2型糖尿病患者颈动脉粥样硬化病变的回声特征有关，但与颈总动脉内膜中层厚度或颈内动脉狭窄程度无关。DD型基因型可能与无回声斑块所特有的心血管风险增加有关。
