缬沙坦对糖尿病肾病合并难治性高血压AT1受体自身抗体阳性患者的临床研究

Effects of valsartan in treatment of the positive AT1-adrenergic receptor the patients diabetic nephropathy with refractory hypertension

目的观察缬沙坦对AT1受体自身抗体阳性的糖尿病肾病（DN）合并难治性高血压患者降压作用的临床疗效。方法以合成的AT1受体多肽片段为抗原，应用酶联免疫吸附法检测DN合并二期以上高血压患者161例，其中DN合并难治性高血压91例，AT1受体自身抗体阳性71例（78．0％），DN合并非难治性高血压70例。AT1受体自身抗体阳性11例（15．7％）。将AT1受体自身抗体阳性的DN合并难治性高血压患者71例，随机分为两组：对照组（30例）：给予卡托普利25mg每日3次，尼群地平20mg每6h1次，氢氯噻嗪12．5mg每日1次，肠溶阿司匹林100mg每日1次；治疗组（41例）：给予缬沙坦160mg每日1次，尼群地平20mg每6h1次，氢氯噻嗪12．5mg每日1次，肠溶阿司匹林100mg每日1次。结果临床降压效果评定，治疗组总有救率为85．4％。明显高于对照组的3313％，两组比较差异有统计学意义（P〈0．01）。结论对AT1受体自身抗体阳性的DN合并难治性高血压患者，有针对性地选择AT1受体拮抗剂，可取得满意的临床降压疗效。

Objective To investigate the effects ofvalsartan on the positive ATl-adrenergic receptor the patients diabetic nephropathy（DN） with refractory hypertension. Methods The epitopes of the second extracellular loop of AT1 receptor, was synthesized and used respectively to screen sera autoantibodies from DN with hypertension （n=161 ）, 91 DN with refractory hypertension, and 70 DN with non-refractory hypertension. In DN with refractory hypertension the positive rates of the autoantibodies against AT1-adrenergic receptor were 71 patients （78.0 %）, but in DN with non-refractory hypertension were 11 patients （15.7%）. The positive of 71 cases AT1 -adrenergic receptor the patients DN with refractory hypertension were divided iato two groups （the therapy group of 41 patients and the control group of 30 patients）. In the therapy group, valsartan 160 mg/d, aspilln 100 mg/d, nefrendipine 20 mg,4 times/d,hydrochlomthiazide 12.5 mg/d were given to the patients, while in the control group, aspilin 100 mg/d, nefrendipine 20 mg, 4 times/d,captopril 25 rag,3 times/d,hydrcchlomthiazide 12.5 mg/d, After a 3-month period therapy. Results In the control group, the total effective rate of hypertension improvement was 85.4%. In the therapy group which was higher than that in the control group, in the control group the rates were 33.3%. Conclusion The findings suggest that these autoantibodies against ATrreceptor, may play important roles in the pathogcnesis of the DN with refractory hypertension. Valsartan is shown to be effective and safe in the treatment of DN with refractory hypertension.