缬沙坦对糖尿病肾病伴AT_1受体自身抗体阳性的难治性高血压的疗效

Effects of valsartan on the patients of diabetic nephropathy with refractory hypertension of positive autoantibodies against AT_1-adrenergic receptor

目的观察缬沙坦对血管紧张素Ⅱ1型(AT_1)受体自身抗体阳性的糖尿病肾病(DN)合并难治性高血压的疗效。方法对检测出AT_1受体自身抗体阳性的DN合并难治性高血压患者71例,随机分为治疗组41例及对照组30例。2组均给予尼群地平20mg,po,qid;氢氯噻嗪12.5mg,po,qd;肠溶阿司匹林100mg,po,qd。治疗组加用缬沙坦160mg,po,qd;对照组加卡托普利25mg,po,tid;结果治疗组降压疗效明显优于对照组,临床降压效果评定治疗组总有效率为85.4%,明显高于对照组(33.3%),2组比较差异有高度统计学意义(P<0.01)。结论缬沙坦为AT_1受体选择性拮抗剂,对ATl受体自身抗体阳性的DN合并难治性高血压患者临床降压疗效满意。

AIM To investigate the effects of valsartan on the patients of diabetic nephropathy with refractory hypertension of positive AT1-adrenergic receptor.METHODS The epitopes of the second extracellular loop of AT1 receptor was synthesized and used respectively to screen sera autoantibodies from patients with diabetic nephropathy with hypertension （n = 161）（diabetic nephropathy with refractory hypertension,n = 91 ;and diabetic nephropathy with non-refractory hypertension group,n = 70）by ELISA.In diabetic nephropathy with refractory hypertension the positive rates of the autoantibodies against AT1 receptor （n = 71,78%）were higher than those of patients with non-refractory hypertension group （n = 11,15.7%）（P〈0.01）.The positive autoantibodies against AT1-adrenergic receptor of the patients of diabetic nephropathy with refractory hypertension in 71 cases was randinly dinided into 2 groups：the therapy group of 41 patients and the control group of 30 patients.In the therapy group,valsartan 160 mg,qd,aspirin 100 mg,qd,nitrendipine 20 mg,qid,hydrochlorothiazide,12.5 rag,qd,were given to the patients orally.In the control group,aspirin 100 mg,qd, nirtendipine 20 mg,qid,captopril 25 mg,tid and hydrochlorothiazide 12.5 mg,qd were given orally.RESULTS Effects of valsartan had been significantly improved in the therapy group.While no such obvious improvement was found in the control group.The total effective rate of hypertensive improvement was 85.4%.In the therapy group which was higher than that of control group.In the control group,the total effective rates were 33.3%（P〈0.01）.CONCLUSION The findings suggest that these autoantibodies against AT1-receptor may play important roles in the pathogenesis of the diabetic nephropathy with refractory hypertension.Valsaaan is shown to be effective and safe in the treatment of diabetic nephropathy with refractory hypertension.