·糖尿病性肾脏疾病·

　　赵林双 孙慧伶 向光大 廖玉华 王敏 侯洁 乐岭

　　作者单位：430070武汉，广州军区武汉总医院内分泌科(赵林双、向光大、侯洁、乐岭、孙慧伶);华中科技大学同济医学院协和医院心内科(廖玉华、王敏)

　　基金项目：湖北省自然科学基金资助项目(2002AB116)

　　【摘要】 目的 探讨美托洛尔联合贝那普利对β1肾上腺素受体(β1受体)和血管紧张素Ⅱ受体1型(AT1)受体自身抗体阳性的糖尿病肾病(DN)患者尿白蛋白的影响。 方法 以合成的β1和AT1受体多肽片段为抗原，应用ELISA技术，检测471例DN患者(DN组)、107例2型糖尿病患者(T2DM组)、47名正常对照者(NC组)的β1和AT1受体自身抗体。DN组中β1和AT1受体自身抗体均阳性的为Ab+组，其余为Ab-组。Ab+组和Ab-组均给予美托洛尔25～50 mg，日3次;贝那普利10 mg，日1次;尼群地平10～20 mg，日3次;阿司匹林100 mg，日1次，口服。用ELISA技术测定尿白蛋白排泄率。 结果 (1)DN组抗β1和AT1受体自身抗体阳性率分别为54.6%(257/471)和51.2%(241/471)，两抗体均阳性为50.3%(237/471)，均明显高于T2DM组的15.9%(17/107)、10.2%(11/107)和8.4%(9/107)，以及NC组的10.6%(5/47)、8.5%(4/47)和6.4%(3/47)(P<0.01)。(2)DN组中Ab+组尿白蛋白降低明显优于Ab-组(P<0.01)。 结论 美托洛尔联合贝那普利治疗β1和AT1受体自身抗体阳性的DN患者，其降低白蛋白尿的疗效明显提高，靶向治疗具有重要的临床价值。

　　【关键词】糖尿病肾病;β1肾上腺素受体;血管紧张素Ⅱ受体1型;自身抗体;美托洛尔;贝那普利

　　doi:10.3969/j.issn.1006-6187.2011.04.006

　　Effects of combined therapy with metoprolol and benazepril on urinary albumin excretion in diabetic nephropathy patients with positive autoantibodies against β1-adrenergic and AT1 receptor

　　ZHAO Lin-shuang, SUN Hui-ling, XIANG Guang-da, et al. Department of Endocrinology, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China

　　【Abstract】 Objective To observe effect of combined therapy with metoprolol and benazepril on urinary albumin excretion rate (UAER) in diabetic nephropathy (DN) patients with positive auto-antibodies against β1-adrenergic and AT1 receptor. Methods The study subjects included DN (n=471), T2DM (n=107) and normal control (n=47). Autoantibobies against β1-adrenergic and AT1 receptor, as well as UAER were determined by ELISA. Both positive and negative autoantibodies groups were given metoprolol 25～50 mg three times daily， benazepril 10 mg daily, nitrendipine 10～20 mg three times daily, aspirine 100 mg daily. Results The DN group showed higher positive rates of β1R-Ab, AT1R-Ab and β1R-Ab+AT1R-Ab (54.6%, 51.2% and 50.3%, respectively) than did T2DM (15.9%, 10.2%, 8.4%, respecbively) and did normal control (10.6%, 8.5% and 6.4%, respectively) (P<0.01). The UAER decrement was higher in Ab(+) group than in Ab(-) group.ConclusionThe combined therapy of DN patients with β1R-Ab(+) and AT1 R-Ab(+) with metoprolol and benazepril could obviously reduce UAER. Immunologically targeted therapy has a very important clinical value.

　　【Key words】Diabetic nephropathy; β1 adrenergic receptor; AT1 receptor; Autoantibodies; Metoprolol tartrate; Benazepril