血管紧张素转换酶基因插入/缺失多态性与IgA肾病关联性Meta分析

摘要

Objective To explore whether there existed an association between angiotensin converting enzyme(ACE) gene insertion/deletion (I/D) polymorphism and lgA nephropathy ( IgAN ). Methods A computerized literature search from PubMed, Cochrane Library, CNKI and VIP Database from the early establishment to Mar. 1,2010 was conducted and all the relative investigations were collected. The studies ineluded Meta - analysis according to the inclusion criteria. All the data were calculated by Revman 4.2.8. When the data were dichotomous, the pooled value of the odds ratios(OR) and 95％ confidence interval(95％ CI) were calculated. The ORs for D/I, DD/( ID + Ⅱ) and Ⅱ/ ( ID + DD) were calculated. The pooled statistics were calculated by using the fixed effect model if P value of heterogeneity test was more than 0. 1, but a random effect model was conducted if P value of heterogeneity test was less than 0. 1. Results Twenty articles were identified for the analysis of relation between ACE polymorphism and IgAN risk ,including 11 cases of Asians and 9 cases of Caucasians. The distribution of D allele in Caucasians was much higher when compared with that in Asians(57.6％ vs 32.6％ ). There was a markedly positive association between D allele or DD genotype and IgAN risk in Asians( OR = 1.27 ,P = 0.006 0; OR = 1.83,P ＜ 0.000 1 ). However, a link between D allele or DD genotype and IgAN risk waan't found in Caucasians ( OR = 1.04,P = 0.460 0;OR = 1.13,P = 0. 120 0 ). Interestingly, the Ⅱ genotype might not play a protective role against lgAN onset in Caucasian population( OR = I. 05 ,P = 0.580 0 ), but the effect was positively significant in Asians ( OR = 0. 81, P = 0.020 0). Conclusion ACE gene I/D polymorphism is associated with IgAN risk and IgAN progression in Asians, but not for Caucasian population.%目的 探讨不同人群中血管紧张素转换酶(ACE)基因插入(I)/缺失(D)多态性与IgA肾病(IgAN)发病的关系.方法 检索PubMed、Cochrane图书馆、清华同方、重庆维普数据库,时间从该数据库建立至2010年3月1日.全面收集有关IgAN ACE I/D基因多态性研究文献,根据文献纳入标准纳入相关文献.应用Revman 4.2.8 软件进行Meta分析,计数资料采用优势比(OR)及其95%CI表示,对IgAN组和健康对照组等位基因D/I,DD/(ID+II)和II/(ID+DD)进行分析.亚组内各研究间无统计学异质性(P≥0.1)时,采用固定效应模型;研究间存在统计学异质性(P<0.1)时,采用随机效应模型.结果 纳入20篇符合条件的文献,其中11篇是在亚洲人中进行研究,9篇是对欧洲人群的研究.健康欧洲人群D等位基因的表达比健康亚洲人群高(57.6% vs 32.6%);亚洲人群中D等位基因和DD基因型与IgAN发病关系密切(OR=1.27,P=0.006 0;OR=1.83,P＜0.000 1);而与欧洲人IgAN的发病无明显相关(OR=1.04,P=0.460 0;OR=1.13,P=0.120 0).在亚洲人群中,II基因型是IgAN发病的一种保护性因素(OR=0.81,P=0.020 0),而欧洲人群未发现有关系(OR=1.05,P=0.580 0).结论 亚洲人ACE I/D基因多态性与IgAN的发病关系密切,而欧洲人群未见两者有联系.