·糖尿病临床研究·　　

2型糖尿病患者G蛋白偶联型β1和血管紧张素II 1受体抗体与冠心病的关系的研究

　　赵林双 廖玉华 向光大 王敏 乐岭 周子华 孙慧伶 谭学莹 白伟伟

　　【摘要】 目的 探讨T2DM患者血清抗血管紧张素II 1受体(AT1受体) 和β1受体自身抗体(β1受体)与冠心病的关系。方法 随机选择 T2DM患者371例和正常对照者40名。以合成的AT1和β1受体多肽片段为抗原，应用ELISA法检测被试血清中抗G-蛋白偶联型AT1和β1受体自身抗体。使用超声心动图检查评价心脏结构和功能。多元Logistic回归分析T2DM患者冠心病的影响因素。结果 (1)T2DM组抗AT1和β1受体抗体阳性率明显高于对照组(P<0.01)。(2)糖尿病患者中，AT1受体抗体阳性组冠心病发生率明显高于受体抗体阴性组(P<0.01);β1受体抗体阳性组冠心病发生率明显高于受体抗体阴性组(P<0.01);(3)多元Logistic回归分析显示，4个危险因素与T2DM伴冠心病相关，即病程、SBP、β1和AT1受体抗体(P<0.05)。结论 糖尿病合并冠心病可能与血清β1和AT1受体自身抗体参与有关，该抗体阳性预测糖尿病合并冠心病具有重要意义。

　　【关键词】糖尿病，2型; 冠状动脉疾病;受体, 血管紧张素, 1型 ;受体, 肾上腺素能β1; 自身抗体

Relationship of autoantibodies against adrenergic β1 receptors and angiotensin II Type 1 receptors with the coronary heart disease in T2DM patients ZHAO Lin-shuang, LIAO Yu-hua, XIANG Guang-da, et al. Department of Endocrinology, Wuhan General Hospital of Guangzhou Military Command, Wuhan 430070, China

　　【Abstract】 Objective To explore the relation of autoantibodies against Angiotensin II Type 1 Receptor (AT1-receptor) and β1 adrenergic receptor (β1-receptor) with the coronary heart disease in T2DM patients. Methods A total of 371 T2DM patients and 40 normal controls were studied. The epitopes of the second extracellular loop of β1 receptor (197-222) and AT1 receptor (165-191) were synthesized and used as antigen to screen the serum autoantibodies by enzyme-linked immunosorbent assay (ELISA). The cardiac structure and function was examined by the echocardiography. By multivariate logistic regressions, the risk factors for the T2DM patients with the coronary heart disease were analyzed. Results The positive rates of the autoantibodies against AT1 receptors and β1 receptors in T2DM patients were significantly higher than those in healthy controls (P<0.01). The incidence of the coronary heart disease in T2DM patients with positive autoantibodies against AT1 receptor was significantly higher than that in those with negative autoantibodies (P<0.01). The incidence of the coronary heart disease in T2DM patients with positive autoantibodies against β1 receptor was significantly higher than that in those with negative autoantibodies (P<0.01). Multivariate Logistic regression analysis showed that there were 4 risk factors related with the coronary heart disease in T2DM patients, including course of disease, systolic blood pressure, autoantibodies against β1 and AT1 receptors in the serum (P<0.05). Conclusion The autoantibodies against serum β1 and AT1-receptors are related with the coronary heart disease in T2DM patients. These positive autoantibodies are significant in forecasting the development of the T2DM accompanied with CHD.

　　【Key words】Diabetes mellitus, type 2; Coronary artery disease; Angiotensin II type 1 receptor (AT1-receptor); Adrenergicβ1 receptor (β1-receptor); Autoantibody