AT_1受体自身抗体阳性糖尿病合并高血压慢性充血性心衰患者靶向治疗研究

Study of Targeted Therapy of Positive AT_1 Receptor Autoantibody Diabetic Patients with Chronic Congestive Heart Failure(CHF) Caused by Hypertension

目的:观察血管紧张素Ⅱ1型(AT1)受体自身抗体阳性的糖尿病(DM)合并高血压慢性心衰患者经缬沙坦靶向治疗慢性充血性心衰患者的临床疗效。方法:以合成的AT1受体多肽片段为抗原,应用ELISA技术,检测DM合并高血压舒张功能不全者116例,DM合并高血压但心功能正常者60例,正常对照组60例的AT1受体自身抗体,以AT1受体自身抗体阳性为治疗组,阴性为对照组,两组均给予尼群地平10mg/天、双氢克尿噻12.5mg/天、肠溶阿斯匹林100mg/天、硝酸异山梨醇酯10mg/天、狄高辛12.5mg/天、缬沙坦160mg/天治疗,6个月为一疗程,通过双盲方法,采用超声心动图对比观察两组的心功能变化情况。结果:(1)DM合并高血压慢性心衰患者AT1受体自身抗体阳性者69/116,阳性率为59.50%,明显高于心功能正常者(8/60,13.3%)及正常对照组(6/60,10.0%)(P<0.01)。(2)药物治疗6月后,治疗组心功能改善明显优于对照组(P<0.01)。(3)临床降压效果评价:治疗组总有效率为91.30%,明显高于对照组的51.16%(P<0.01)。结论:对DM合并高血压慢性心衰患者,通过AT1受体自身抗体检测,有针对性给予缬沙坦治疗,可明显改善心功能。

Objective: To investigate the effects of Valsartan targeted therapy on the positive AT1 receptor autoantibody diabetic patients with hypertension.Method: AT1 receptor autoantibody of patients with the cardiac failure,diabetes mellitus and hypertension (n=116),patients of the diabetes mellitus with hypertension(n=60) and normall healthy group(n=60) were examined by ELISA. The two groups (therapy group:positive AT1 receptor autoantibody and control group:negative autoantibody were given the following drugs:Valsartan 160 mg·d-1; Aspilin 100 mg·d-1; Niqundiping 10 mg ·d-1 hydrochlorothiazide 12.5 mg·d-1 ;Isosorbide dinitrate 10 mg·d -3;Digaoxin 12.5 mg·d-1;for a 6-month period of therapy.Results: (1)Positive rate of the autoantibody against AT1 receptor in DM with heart failure group(n=69)was 59.5%, higher than those of patients with non-cardiac failure group(n=8)13.3% (P<0.01). (2)Heart function had been significantly improved in therapy group(P<0.01). (3)The total effective rate was 91.3% in the therapy group,which was significantly higher than that of negative group(51.1%). Conclusion: The findings suggest that detection of autoantibody against AT1-receptor and valsartan targeted therapy was shown to be effective and safe in the treatment of diabetes mellitus with hypertension caused CHF patients.