缬沙坦靶向治疗糖尿病合并高血压心功能不全的临床研究  

Effects of Valsartan in Treatment of the Positive AT_1 Receptor in Patients of Cardiac Failure with Diabetes Mellitus and Hypertension

作　　者：赵林双[1] 孙慧伶[1] 廖玉华[2] 王敏[2] 周子华[2] 向光大[1] 侯洁[1] 乐岭[1] 

机构地区：[1]中国人民解放军广州军区武汉总医院内分泌科,湖北武汉430070 [2]华中科技大学同济医学院心血管病研究所,湖北武汉430022

出　　处：《医学临床研究》2007年第2期218-221,共4页Journal of Clinical Research

摘　　要：【目的】观察抗AT1受体自身抗体阳性的糖尿病合并高血压心功能不全患者缬沙坦靶向治疗对心功能的疗效。【方法】以合成的AT1受体多肽片段为抗原,应用ELISA技术,检测糖尿病合并高血压心功能不全者116例(其中抗体阳性者69例,阴性者47例),糖尿病合并高血压无心功能不全者60例;正常对照组60例。合并心功能不全者给予:尼群地平10 mg,4次/d;氢氯噻嗪12.5 mg/d;肠溶阿斯匹林100 mg/d;硝酸异山梨醇酯(isosorbide dinitrate)10 mg,3次/d;狄高辛12.5 mg/d;缬沙坦160 mg/d。6个月为一疗程,通过双盲方法,采用超声心动图进行对比观察。【结果】①糖尿病合并高血压心功能不全者AT1受体自身抗体阳性率(69/116,59.5%),明显高于糖尿病合并高血压无心功能不全者(8/60,13.3%)及正常对照组(6/60,10.0%)(P<0.01)。②LVEDV、LVESV、EF,E峰、A峰、E/A比值、VTIE、VTIA、E-VTI/A-VTI抗体阳性组疗效明显优于阴性组(P<0.05)。③临床降压效果评定,AT1受体自身抗体阳性组总有效率(91.3%),明显高于对照组(40.4%),(P<0.01)。【结论】对糖尿病合并高血压心功能不全者,通过抗AT1受体自身抗体检测,对阳性者有针对性选择缬沙坦,可改善糖尿病患者心功能,且较安全。[Objective]To investigate the effects of Valsartan on the positive AT1 receptor in patients cardiac failure with the diabetes mellitus and hypertension. [Methods]The epitopes of the second extrac ellular loop of AT1 receptor （165-191） was synthesized and used respectively to screen sera autoantibodies from patients of cardiac failure of the diabetes mellitus and hypertension （ n = 116）, patients without cardiac failure of the diabetes mellitus with hypertension （ n =60）, normall group （ n =60） by ELISA. The two groups （the therapy group with the positive AT1 receptor and the control negative AT1 receptor ） were given the following drugs; Valsartan160 mg/d; Aspilin100mg/d; Niqundiping 10mg, Q6h ; hydrochlorothiazide 12. 5mg/d ; Isosorbide dinitrate10mg/d; Digaoxin12.5mg/d ;were given to the patients for 6-month period. [Results]①In cardiac failure of diabetes mellitus with hypertension the positive rates of the autoantibodies against AT1 receptor were （ n =69）59.5%, higher than those without cardiac failure（ n =8）（13.3%, P d0. 01）, ② Effects of Valsartan treatment of left ventricular diastolic function and of left ventricular systolic function had been significantly improved in 69 cases of positive AT1 receptor,while no such obvious improvement in 47 Cases of negative AT1 receptor, ③The total effective rate of cardiac function improvement was 91.3 % in the positive group, higher than that in the negative group （40.4 %）. [Conclusion]These autoantibodies against ATe-receptor may play important roles in the pathogenesis of cardiac failure of the diabetes mellitus with hypertension. Valsartan is effective and safe in the treatment of cardiac failure of diabetes mellitus with hypertension.

关 键 词：糖尿病/并发症 高血压/并发症 心力衰竭 充血性/药物疗法 缬氨酸/治疗应用 

分 类 号：R541.61[医药卫生—心血管疾病]