糖尿病肾病患者血清抗AT1和α1受体抗体与肾小球滤过率的关系

Relation between Autoantibodies against AT1 Receptor and α1-adrenergic and Glomeruar Filtration Rate in Patients with Diabetic Nephropathy

目的探讨糖尿病肾病(diabetic nephropathy,DN)患者血清抗血管紧张素II 1型受体自身抗体(angio-tensinⅡtype 1receptor activating antibody,AT1-AA)和抗α1肾上腺素能受体(α1-R)自身抗体与肾小球滤过率(glo-merular filtration rate,GFR)降低的相关性。方法①以合成的AT1受体和α1受体多肽片段为抗原,应用酶联免疫吸附测定(enzyme-linked immunosorbent assay,ELISA)技术,检测371例DN患者(A组)、107例2型糖尿病(type 2diabe-tes mellitus,T2DM)患者(B组)、47例正常对照(C组)自身抗体。②肾动态显像,采用同位素99 Tcm标记法测定GFR。③ELISA技术测定尿白蛋白排泄率(urinary albumin excretion rate,UAER)。结果①A组AT1和α1受体抗体阳性率分别为51.5%和47.7%,明显高于B组(19.5%和15.9%)及C组(10.6%和8.5%),P<0.05。②A组中,GFR异常者AT1和α1受体抗体阳性率分别为59.5%和63.1%,明显高于GFR正常者的30.5%和35.1%(P<0.01)。③A组中,GFR异常组中AT1和α1受体抗体均阳性者130例,阳性率为59.9%,显著高于GFR正常组(17.5%,27/154,P<0.01)。结论 DN患者GFR降低,血清抗AT1和α1受体抗体阳性率明显升高,糖尿病肾功能不全与抗AT1和α1受体自身抗体有关。

Objective To observe the relation between the autoantibodies against α1-adrenergic receptor and AT1 receptor and the glomerular filtering coefficient（GFR） in the patients with diabetic nephropathy（DN）.Methods The epitopes of the second extracellular loop of α1 receptor（192-218） and AT1 receptor（165-191） were synthesized and used respectively to screen sera autoantibodies of 371 DN patients（group A）,107 patients with type 2 diabetes mellitus（T2DM） but no renal failure（group B） and 47 healthy controls（group C） by enzyme-linked immunosorbent assay（ELISA）.GFRs and urinary albumin excretion rate（UAER） were assayed by istop 99Tcm-labblde method and ELISA respectively.Results The positive rate of the autoantibodies against AT1 receptor and α1 receptors was 51.5% and 47.7% respectively in group A,which was significantly higher than that in group B（19.5% and 15.9%） and group C（10.6% and 8.5%,P0.05）.These positive rates in DN patients in group A with abnormal GFR was 59.5% and 63.1% respectively,which was significantly higher than that in DN patients in group A with normal GFR（30.5% and 35.1%,P0.01）.In DN patients in group A with abnormal GFR,the positive rate of the both autoantibodies was 59.9%（130/217）,which was significantly higher than that with normal GFR（17.5%,27/154,P0.01）.Conclusion DN patients have decreased GFR and increased positive rates of the autoantibodies against AT1 receptor and α1 receptors.Renal dysfunction of DM patients are related with these autoantibodies.