糖尿病心肌病患者血管紧张素Ⅱ1型受体自身抗体与血管内皮生长因子的相关性

Correlation between autoantibody against angiotensin Ⅱ type 1 receptor and vascular endothelial growth factor in patients with diabetic cardiomyopathy

目的探讨糖尿病心肌病(diabetic cardiomyopathy,DCM)患者血清血管紧张素Ⅱ1型受体(angiotensinⅡtype 1receptor,AT1R)自身抗体与血管内皮生长因子(vascular endothelial growth factor,VEGF)的关系,为早期靶向治疗改善心脏结构和功能提供理论依据。方法随机选择101例DCM患者和73例2型糖尿病(T2DM)患者,并将40例健康体检者作为正常对照组,采用酶联免疫吸附法(ELISA)测定3组受检者AT1R自身抗体和血清VEGF水平;通过超声心动图评价DCM患者心脏结构和心功能,分析心脏扩大程度与AT1R自身抗体及血清VEGF水平的关系;比较AT1R自身抗体阳性和阴性组患者的VEGF水平。结果 DCM组血清VEGF水平[(312.2±12.2)ng/ml]和AT1R自身抗体阳性率(50.5%)明显高于T2DM组[(98.7±4.6)ng/ml、23.3%]和正常对照组[(40.7±2.2)ng/ml、10.0%],差异均有统计学意义(P<0.01)。T2DM组血清VEGF水平和AT1R自身抗体阳性率明显高于正常对照组,差异均有统计学意义(P<0.01,P<0.05)。DCM患者心脏重度扩大组VEGF水平[(369.3±57.6)ng/ml]明显高于中度扩大组[(115.2±10.7)ng/ml]及轻度扩大组[(117.0±11.1)ng/ml],差异均有统计学意义(P<0.01);3组间AT1R自身抗体阳性率差异无统计学意义(P>0.05)。DCM患者AT1R自身抗体阳性组VEGF水平[(377.3±31.7)ng/ml]明显高于AT1R自身抗体阴性组[(153.7±17.1)ng/ml],差异有统计学意义(t=44.02,P<0.01)。结论 DCM发病可能与VEGF和AT1R自身抗体参与有关,二者可能在DCM发生发展过程中具有一定的作用。

Objective To explore the relationship between autoantibody against angiotensin Ⅱ type 1 receptor（AT1R） and vascular endothelial growth factor（VEGF） in patients with diabetic cardiomyopathy（DCM） and to provide the basis for early treatment.Methods The levels of serum VEGF and autoantibody AT1 R were measured by ELISA in 101 patients with DCM,73 patients with type 2 diabetic patients（T2DM） and 40 control subjects. Echocardiography was used to evaluate the cardiac structure and function.The relationship among the left ventricular（LV） enlargement,autoantibody AT1 R and serum VEGF level was analyzed. The serum VEGF levels between patients with positive autoantibody AT1 R and patients with negative autoantibody AT1 R were compared.Results The levels [（312.2±12.2） ng/ml] of VEGF and positive rate（50.5%） of autoantibody against AT1 R in DCM group were significantly higher than those [（98.7±4.6） ng/ml and 23.3%] in T2 DM group（P〈0.01）,which also were significantly higher than those [（40.7±2.2） ng/ml and 10.0%] in control subjects（P〈0.05）. The level [（369.3±57.6） ng/ml] of VEGF in DCM patients with severe LV dilatation was significantly higher than those [（117.0±11.1） and（115.2±10.7） ng/ml] in DCM patients with light and moderate LV dilatation（P〈0.05）. But there were no significant differences for the positive rate of autoantibody against AT1 R among three groups（P〉0.05）.The serum VFGF level [（377.3±31.7） ng/ml] in DCM patients with positive autoantibody against AT1 R was significantly higher than that [（153.7±17.1） ng/ml] in DCM patients with positive autoantibody against AT1R（P〈0.01）.Conclusion The VEGF and autoantibodies against AT1 R may play important roles in the pathogenesis of DCM.