急性冠状动脉综合征血管紧张素Ⅱ1型受体自身抗体表达及缬沙坦的干预效应  

Expression of autoantibodies against angiotensinⅡ type 1 receptor in acute coronary syndrome and intervention effects of valsartan

作　　者：陈永清[1] 张明旭[1] 刘丽华[1] 党涛[1] 白志冬[1] 王煜[1] 杨鹏[1] 

机构地区：[1]兰州军区兰州总医院干一科,甘肃兰州730050

出　　处：《临床荟萃》2014年第6期637-639,共3页Clinical Focus

基　　金：甘肃省科技计划资助项目(1308RJZA135)

摘　　要：目的检测急性冠状动脉综合征(ACS)患者外周血中血管紧张素Ⅱ1型受体自身抗体(AT1-AAs)表达,探讨血管紧张素Ⅱ受体拮抗剂(ARB)对AT1-AAs表达阳性的ACS患者的治疗作用。方法选择未行介入治疗的ACS患者87例和正常健康对照组60例,人工合成血管紧张素Ⅱ受体细胞外第二环功能表位肽段,采用酶联免疫吸附法(ELISA)检测患者外周血中AT1-AAs表达阳性率及单核细胞趋化蛋白-1(MCP-1)、高敏C反应蛋白(hsCRP)的表达水平;ACS患者分为2组:AT1-AAs阳性组及阴性组,组内随机给予缬沙坦或常规治疗10天,观察MCP-1和hsCRP水平的变化。结果①ACS组及正常对照组中AT1-AAs表达阳性率分别为46.0%(40/87)和5.0%(3/60),ACS组明显高于正常对照组(P<0.01),ACS组患者MCP-1和hsCRP水平亦明显高于正常对照组(P<0.01);②治疗前,AT1-AAs阳性组ACS患者MCP-1和hsCRP水平明显高于AT1-AAs阴性组(P<0.01);AT1-AAs阳性患者采用缬沙坦治疗后,MCP-1和hsCRP水平明显低于AT1-AAs阳性常规治疗者(P<0.01),AT1-AAs阴性患者,采用缬沙坦治疗后MCP-1和hsCRP水平较常规治疗有降低趋势,但差异无统计学意义(P>0.05)。结论 AT1-AAs可能参与ACS的发病过程,对AT1-AAs阳性的ACS患者给予ARB药物治疗获益更大。Objective To detect the expression of autoantibodies against angiotensin Ⅱ type 1（AT1）receptor （AT1-AAs）in acute coronary syndrome（ACS）patients and to study the intervention effects of valsartan on ACS patients.Methods Eighty-seven patients with ACS without undergoing intervention therapy were enrolled in this study.Sixty healthy people were selected as healthy control group.The epitopes of the second extracellular loop of AT1-receptor（165-191）were synthesized and used as antigens to screen the serum autoantibodies by enzyme-linked immunosorbent assay（ELISA）.The peripheral blood levels of monocyte chemoattractant protein-1 （MCP-1 ）and high-sensitivity C-reactive protein（hsCRP）were also evaluated with ELISA.The patients of ACS were divided into AT1-AAs positive group and negative group.Effects of valsartan or normal treatment on MCP-1 and hsCRP were observed. Results ①The positive rates of AT1-AAs in ACS group and healthy control group were 46.0%（40/87）and 5.0%（3/60）,respectively.The positive rate of AT1-AAs in ACS group was significantly higher than that in control group（P〈0.01）.The peripheral blood levels of MCP-1 and hsCRP were significantly higher in ACS group than those in control group（P〈0.01）.②Before treatment,the levels of MCP-1 and hsCRP were significantly higher in AT1-AAs positive group than those in AT1-AAs negative group（P〈0.01）.After ten days’treatment with valsartan,the levels of MCP-1 and hsCRP in AT1-AAs positive patients were significantly lower than those in normal treatment AT1-AAs positive patients（P〈0.01）.But in AT1-AAs negative group,these levels in valsartan group were only slightly lower than those in normal treatment group（P〉0.05）.Conclusion AT1-AAs may play an important role in the pathogenesis of ACS.In AT1-AAs positive patients,more benefits can get through treatment with valsartan.

关 键 词：急性冠状动脉综合征 血管紧张素Ⅱ1 型受体拮抗剂 自身抗体 

分 类 号：R541.6[医药卫生—心血管疾病]