贝那普利对高血压并糖尿病肾病抗AT1受体自身抗体阳性患者肾脏的保护作用

目的探讨抗血管紧张素转换酶抑制剂贝那普利对高血压并糖尿病肾病（DN）抗AT1受体自身抗体阳性患者血压及尿蛋白的影响。方法以合成的AT1受体多肽片段为抗原，应用酶联免疫吸附测定技术，检测71例高血压并DN患者和51例糖尿病患者，及正常对照组40例血清抗AT1受体自身抗体。对抗AT1受体自身抗体阳性和阴性的DN患者分别在原胰岛素降糖方案治疗基础给予贝那普利10mg，口服，1次／d；尼群地平10mg，口服，3次／d；双氯噻嗪12．5mg，口服，1次／d；阿司匹林100mg，口服，1次／d。观察贝那普利对AT1受体自身抗体阳性组和阴性组临床降压及尿蛋白的疗效。6个月为一疗程，治疗前后进行24h尿微量白蛋白测定。结果高血压并DN组抗AT1受体自身抗体阳性率（43．7％，31／71）明显高于2型糖尿病组（13．7％，7／51）和对照组（10％，4／40）。临床降压疗效总评定，DN抗AT1受体自身抗体阳性组和阴性组贝那普利治疗总有效率分别为85．6％和45．0％；临床降蛋白尿的疗效总有效率分别为87．1％（27／31）和42．5％（17／40），两组比较差异具有显著的统计学意义（P〈0．01）。结论贝那普利对高血压合并DN抗AT1受体自身抗体阳性组降压和减少蛋白尿的疗效明显优于阴性组，有针对性的治疗具有重要的临床价值。

Benazepril in treatment of autoantibodies against AT1 receptor positive hypertension patients with diabetic nephropathy

Objective To investigate the effects of benazepril on the blood pressure and urinary protein in AT1-adrenergic receptor positive hypertension patients with diabetic nephropathy（DN）. Methods The synthesized epitopes of the second extracellular loop of AT1 receptor （165- 191） was used to screen serum autoantibodies from hypertension patients with DN （n = 71）, diabetic mellitus （n = 51 ） and from healthy blood donors （n = 40, control） by ELISA. The patients in autoantibodies against AT1 receptor positive group （n= 31） and negative group（n = 40） were given the following drugs repectively., benazepril （10mg/d）, aspirin（100mg/d）, nitrendipine （10mg/d）. The blood pressure reducing effect was compared between the groups. The 24 hour urinary protein were measured before and after treatment for 24 weeks. Results In hypertension patients with DN, the positive rate of the autoantibodies against AT1 receptor was 43.7 % （31/71）, and was significantly higher than that in the diabetes mellitus patients （13.7%, 7/51）and healthy blood donors（10%, 4/40, P〈0.01）. The total efficiency rate of benazepril treatment in reducing blood pressue was significantly higher in autoantibodies against AT1 receptor positive group than that in negative group （85.6 % vs 45.0 %, P〈0.01）. The total efficiency rate of benazepril treatment in reducing urinary protein was sig nificantly higher in autoantibodies against AT1 receptor positive group than that in negative group （87. 1% vs 42. 5%,P〈0.01）. Conclusion Benazepril can reduce urinary protein more significantly in hypertension patients with DN and positive autoantibodies against AT1 receptor than that in those with negative autoantibodies against AT1 receptor. Benazepril is effective and safe in the treatment of hypertension with DN.