O polimorfismo I/D do gene ECA e nefropatia diabética: evidências baseadas em meta-análises
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2018-06-04
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Universidade Federal de Goiás
Resumo
Diabetic Nephropathy (DN) is a microvascular renal complication of Diabetes Mellitus (DM),
characterized by increased albuminuria and progressive loss of renal function. A cumulative
incidence of ND in the last 10 years was observed in 40%, mainly in patients with type 2
diabetes mellitus (T2DM), being an important cause of morbidity and mortality among these
individuals. The Insertion / Deletion (I/D) polymorphism in the ACE gene could influence the
predisposition to DN by vascular modulation in the kidney, through a direct effect on the
cellular hypertrophy, influencing the proliferation and the rupture of the extracellular matrix.
Many studies about this subject are discordant, a fact that increases the need for joint
analysis so that safe conclusions can be generated. The aim of this study was to investigate
the association between ACE gene I/D polymorphism and the development of DN in patients
with T2DM. Through a standardized research protocol, the bibliographic search was performed
in the PubMed and Cochrane Library electronic databases of 1995-2017, selecting case-control
observational studies using the terms "polymorphism" AND " ACE gene" AND “diabetic
nephropathy ". We included 33 studies in qualitative synthesis and 30 studies for meta-
analysis, with 9.077 participants with T2DM genotyped, 4.774 (52, 6%) individuals with DN
and 4.303 (47. 4%) individuals without DN. Evaluated separately, the genotypes for the case
group, we have I/I (23, 5%), I/D (46, 4%) and D/D (30, 6%). The genotypes for the control
group, I/I (28, 6%), I/D (46.19%) and D/D (25%). The highest prevalence observed was of
the I/D genotype in both groups. In the allele frequencies calculated by the Hardy-Weinberg
Test, the mutant D allele presents with 54% in the case group and 48% in the control group.
The wild-type I allele was present in 46% in the case group and 52% in the control group.
The present meta-analysis concludes the I/D polymorphism of the ACE gene studied through
the I/D and D/D genotypes is not associated with the risk of developing DN in individuals with
T2DM, but the presence of the D allele has significant significance in the risk of developing the
disease, as well as the protective role of the I allele.
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SILVEIRA, Luciana Carvalho. O polimorfismo I/D do gene ECA e nefropatia diabética: evidências baseadas em meta-análises. 2018. 64 f. Dissertação (Mestrado em Assistência e Avaliação em Saúde) - Universidade Federal de Goiás, Goiânia, 2018.