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目的观察哌唑嗪联合缬沙坦治疗α1和AT_1受体自身抗体阳性的T2DM合并难治性高血压(R HT)的疗效。方法以合成的α1和AT_1受体多肽片段为抗原,应用ELISA技术,检测282例人血清抗α1和AT_1受体自身抗体:DM合并R-HT者117例(DM+R-HT组),DM合并非R-HT 119例(DM+NR-HT组),正常对照46名(NC组)。其中DM+R-HT组中抗α1和AT_1受体自身抗体均阳性者37例为RAAb(+)组,两受体自身抗体均阴性者30例为RAAb(-)组。RAAb(+)组和RRAb(-)组均给予缬沙坦80mg,日一次,口服;哌唑嗪1mg,日三次,口服;尼群地平10mg,日三次,口服;双氯噻嗪12.5mg,日一次,口服;阿司匹林100mg,日一次,口服;观察两组降压疗效。结果 DM+R-HT组抗α1和AT_1受体自身抗体阳性率明显高于DM+NR-HT组和NC组(P均<0.01)。RAAb(+)组降压疗效明显优于RAAb(-)组。临床降压效果评定,RAAb(+)组总有效率为89.2%,RAAb(-)组为60.0%,两组比较差异有统计学意义(P<0.05)。结论对糖尿病合并难治性高血压,通过抗α1和AT_1受体自身抗体检测,有针对性地选择降压药物哌唑嗪和缬沙坦,降压疗效好且较安全。
Objective To observe the efficacy of prazosin plus valsartan in the treatment of T2DM complicated with refractory hypertension (R HT) with α1 and AT1 receptor autoantibodies. Methods The anti-α1 and AT_1 receptor autoantibodies of 282 human serum samples were detected by ELISA using 117 α-AT and AT 1 -receptor peptide fragments as antigens: DM + R-HT group (DM + R-HT group) 119 non-R-HT patients (DM + NR-HT group) and 46 healthy controls (NC group). 37 cases were positive for anti-α1 and AT_1 receptor autoantibodies in the DM + R-HT group, while RAAb (+) was the other cases in the DM + R-HT group. Valsartan 80 mg was given once a day for both RAAb (+) and RRAb (-) groups, once daily, and prazosin 1 mg orally three times daily for treatment with nitrendipine 10 mg three times daily, Day, oral; aspirin 100mg, once daily, oral; observed two groups of antihypertensive effect. Results The positive rates of anti-α1 and AT_1 receptor autoantibodies in DM + R-HT group were significantly higher than those in DM + NR-HT group and NC group (all P <0.01). The antihypertensive efficacy of RAAb (+) group was significantly better than that of RAAb (-) group. The total effective rate of RAAb (+) group was 89.2% and that of RAAb (-) group was 60.0%. The difference between the two groups was statistically significant (P <0.05). Conclusion Diabetic patients with refractory hypertension, anti-α1 and AT1 receptor autoantibodies detection, targeted antihypertensive drugs prazosin and valsartan, antihypertensive effect is good and safer.