糖尿病患者血清抗AT1和α1肾上腺素能受体自身抗体与白蛋白尿的关系

目的探讨糖尿病（DM）患者血管紧张素Ⅱ受体1（AT1受体）和α1肾上腺素能受体（α1受体）自身抗体与白蛋白尿的关系。方法以合成的AT1和α1受体多肽片段为抗原，应用酶联免疫吸附技术，检测171例糖尿病患者（DM组）、60例高血压无肾损患者（HT组）及40例正常人（NC组）血清中抗AT1和α1受体自身抗体及尿白蛋白排泄率（UAER）。DM组根据UAER分为DM1组（UAER≥200μg／min）；DM2组（UAER为20-199μg／min）；DM3组（UAER＜20μg／min）。结果（1）DM组抗AT1和α1受体抗体阳性率分别为53．2％和56．1％，明显高于HT组的13．3％和15．0％及NC组的12．5％和7．5％，差异有统计学意义（P均〈0．01）。（2）DM1组抗AT1和α1受体自身抗体阳性率分别为83．6％和82．O％，明显高于DM2组的66．0％和62．5％及DM3组的11．7％和8．3％，差异有统计学意义（P均〈0．01），DM2组明显高于DM3组（P〈0．01）。结论血清抗G蛋白偶联型AT1和α1受体自身抗体可能与DM合并肾损害有关，AT1和α1受体自身抗体阳性率与白蛋白尿有关。AT1和α1受体自身抗体在DM合并肾损害发病中起重要作用。

The relation of the AT1 recepotor autoantibodies and α1-adrenergic receptor autoantibodies with urinary albumin excretion rate in type 2 diabetes mellitus

Objective To explore relation of the AT1 receptor autoantibodies and α1-adrenergic receptor autoantibodies with urinary albumin excretion rate in type 2 diabetes mellitus. Methods The epitopes of the second extracellular loop of AT1 receptor （165-191）and α1 -receptor （192-218）were synthesized and used respectively to screen several autoantibodies from patients with type 2 diabetes mellitus （DM, n= 171）, hypertension without renal failure （HT, n= 60） and healthy control （NC, n= 40） by ELISA. Urinary albumin excretion rate （UAER） was assayed by ELISA. Results The positive rates of the AT1 -receptors autoantibodies （53.2 %）and α1 receptor autoantibodies （56.1%） in DM group were higher than in HT group （13.3% for AT1 , 15.0% for α1-Adr） （P〈0. 01） and in health control （12. 5% for AT1 ; and 7. 5% for α1-Adr. ） （P〈0. 01）. In the DM1 group（UAER≥200μg/min） the positive rate of the autoantibodies was 83.6% against ATl-receptor and 82.0% against α1-receptor. In the DM2 group （UAER 20-199μg /min） the positive rates of the autoantibodies was 66.0% （33/50） against AT1-receptor and 62.5 % （31/50） against α1 -receptor. In the DM3 group（UAER〈20big/min） the positive rates of the autoantibodies was 11.7%（7/60） against ATl-receptor and 8. 3% （5/60） against α1- receptor. Conclusions The findings suggest that these autoantibodies against AT1 and α1 receptor may play important roles in the pathogenesis of diabetic nephropathy. The AT1 and α1-receptor autoantibodies are related with the UAER level.