贝那普利对糖尿病肾病抗血管紧张素Ⅱ1型受体自身抗体阳性患者肾小球滤过率的影响  

Clinical Evaluation of Benazepril Treatment on GFR in the Diabetic Nephropathy Patients with Positive Angiotensin Ⅱ Type 1 Receptor

作　　者：赵林双[1] 谭学莹[1] 向光大[1] 乐岭[1] 

机构地区：[1]广州军区武汉总医院内分泌科,武汉430070

出　　处：《微循环学杂志》2012年第4期49-51,56,I0002,共5页Chinese Journal of Microcirculation

基　　金：湖北省自然基金课题(NO:2002AB116)

摘　　要：目的:探讨贝那普利对血清抗血管紧张素Ⅱ1型受体自身抗体(AT1-AA)阳性糖尿病肾病(DN)患者肾小球滤过率(GFR)的影响。方法:(1)对368例DN患者采用SPECT同位素99mTc标记法测定GFR,根据测定结果分为GFR异常组(n=214)及GFR正常组(n=154),以合成的AT1受体多肽片段为抗原,应用ELISA技术,检测并比较GFR正常组及GFR异常组AT1-AA阳性率的差异;(2)再将GFR异常组DN患者分为AT1-AA阳性组(A1组,117例)和AT1-AA阴性组(A2组,97例),均在常规胰岛素降糖治疗基础上服用贝那普利(10mg/天)等药物,6个月为一疗程,观察一个疗程及两个疗程治疗前后两组GFR变化。结果:(1)GFR异常组AT1-AA阳性率为54.67%(117/214),明显高于GFR正常组(34.42%,53/154),差异有统计学意义(P<0.01)。(2)一个疗程及两个疗程治疗后,A1组GFR改善均优于A2组,差异有统计学意义(P<0.01);A1组治疗前后自身比较亦有统计学意义(P<0.05)。结论:DN与AT1-AA参与的自身免疫反应有关,贝那普利针对性靶向治疗对肾脏具有重要保护作用。Objective: To observe the effect of benazepril treatment on glomerular filtration rate(GFR) in the diabetic nephropathy (DN) patients with positive AT1 receptor autoantilodies(AT1-AA). Method: (1)GFR of 368 DN patients were assayed by istop 99mTc-labblde methoy.The epitopes of the second extracellular loop of AT1 receptor (165～191), was synthesized and used respectively to screen sera autoantibodies from patients with DN (n=368,DN, A group) by ELISA. (2) The two groups \[the positive of the AT1-AA the therapy group of (A1)117 patients and negative the of the AT1-AA the control group(A2) of 97 patients\] were given the following drugs Benazepril 10mg/d by after 6 and 24 months period therapy.The GFR were measured before and after treatment. Results: (1) In DN patients the positive rates group of the AT1-AA was 54.67%.They were significantly higher than those in patients GFR normal group patients was 34.42%(P<0.01). (2)After 6 and 24 months period therapy,benazepril of effective significantly (P<0.01) in A1 group of DN patients with the positive group of the AT1-AA, they were significantly higher than those in patients with the negative group of the AT1-AA.The A1 group were significantly of affectire before and after treatment(P<0.01). Conclusion: The findings suggest that these AT1-AA may play important roles in the pathogenesis of DN. Benazepril is shown to be effective and safe in the treatment of DN.

关 键 词：肾小球滤过率 血管紧张素Ⅱ1型受体 糖尿病肾病 阳性患者 自身抗体 贝那普利 早期诊断指标 肾脏微血管病变 

分 类 号：R587.1[医药卫生—内分泌]