缬沙坦对糖尿病肾病并高血压AT_1自身抗体阳性患者血压和糖化血红蛋白的影响  

Clinical Evaluation of Valsartan in Treatment of the Positive Autoantibodies Against AT_1 Receptor in Hypertension with Diabetic Nephropathy

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

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5期713-715,718,共4页Journal of Clinical Research

基　　金：湖北省自然科学基金项目(2002AB116)

摘　　要：【目的】探讨抗血管紧张素Ⅱ受体拮抗荆缬沙坦对糖尿痛肾病（DN）合并高血压抗AT】受体自身抗体阳性患者血压和糖化血红蛋白的影响。【方法】以合成的AT，受体多肽片段为抗原，应用酶联免疫吸附测定（ELISA）技术，检测196例DN合并高血压患者血清抗AT1受体自身抗体。①糖尿病肾病合并高血压136例（1组，治疗组）抗AT1受体自身抗体阳性组和阴性组均在原胰岛素降糖方案治疗基础上均给予尼群地平30mg／d，缬沙坦（Valsartan）80～160mg／d，肠溶阿司匹林100mg／d口服，观察受体自身抗体阳性和阴性组降压疗效；2，6，12周为一疗程。②2组糖尿病肾痛合并高血压60例（对照组）不给缬沙坦，余治疗同上，观察不给缬沙坦对此类病人糖化血红蛋白的影响。治疗前及治疗3个月测糖化血红蛋白。【结果】①高血压合并DN治疗组和对照组抗AT1受体自身抗体阳性率分别为52．2％（71／136）和51．7％（60／71）；②抗AT1受体自身抗体阳性组缬沙坦治疗2、6、12周降压疗效达标，与抗AT1受体自身抗体阴性组比较，具有显著的统计学意义（P〈0．05，P〈0．01）；③糖尿病肾病合并高血压患者治疗组缬沙坦治疗后对糖化血红蛋白达标率明显优于对照组。【结论】对于高血压合并糖尿病肾病抗AT1受体自身抗体阳性组，缬沙坦治疗降压效果和糖化血红蛋白达标率明显优于对照组，靶向治疗具有重要的临床意义。[Objective]To observe the effect of angiotensin Ⅱ 1 receptor antagonist（AT1Ra） valsartan in treatment of diabetic nephropathy patients with hypertension. [Methods]The epitopes of the second extracellular loop of AT1 receptor （165-191） were synthesized and used respectively to screen sera autoantibodies from patients of diabetic nephropathy （DN） with hypertension （ n = 196） by ELISA. The two therapy groups （ n = 136） [ the positive autoantibodies against AT1 receptor, （ n = 71 ） and negative autoantibodies against AT1 receptor （ n =65）-]were given the following drugs repectively： Valsartan 80-160 rag/d, Aspirin 100mg/ d, Nitrendipine 30mg/d.. After 12 weeks period therapy, 24-hour urinary protein（UAER） was detected. The control group （ n=60）, patients were not given valsartan,but given aspirin and nitrendipine. After 12 weeks period therapy , glycated hemoglobin（ GHbA1 ） was measured before and after treatment. [Results]In patients of hypertension with DN, the positive rate of autoantibodies against AT1 receptor was 52.2% and 51.7% in therapy group and control group respectively. Hypertension and glycated hemoglobin（GHbA1 ） had been significantly improved （ P 〈0.05, P 〈0.01） in diabetic nephropathy patients with hypertension treated by valsartan. [Conclusion]Valsartan significantly protects renal function and could reduce urinary protein in patients of hypertension with diabetic nephropathy and positive autoantibodies against AT1 receptor.

关 键 词：糖尿病肾病/并发症 高血压/并发症 自身抗体 血压 血红蛋白A 糖基化 四唑类 缬氨酸 

分 类 号：R692.39[医药卫生—泌尿科学]