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目的观察血管紧张素Ⅱ(AngⅡ)AT1受体拮抗剂对AT1受体自身抗体阳性的难治性高血压合并糖耐量减低(IGT)患者降压疗效。方法应用ELISA技术检测237例人血清抗AT1受体自身抗体,其中难治性高血压病合并IGT患者91例(为A组),非难治性高血压病伴IGT患者106例(为B组),健康对照组40例(为C组)。A组中AT1受体自身抗体阳性者39例为A1治疗组,阴性者52例为A2对照组,两组均给予口服:尼群地平10mg/tid;氢氯噻嗪12.5mg/d;肠溶阿斯匹林100mg/d;缬沙坦160mg/d;卡托普利25mg/tid。正常对照组40例。结果①难治性高血压合并IGTAT1受体自身抗体阳性率为57.1%(52/197),明显高于非难治性高血压伴IGT的15.1%和正常对照组的12.5%,比较具有统计学意义。②难治性高血压合并糖耐量减A1组降压疗效明显优于A2组,两组比较具有显著性统计学意义(P<0.05)。③临床降压效果评定,A1组总有效率为84.6%,明显高于A2组51.9%,两组比较具有极显著性意义(P<0.01)。结论对难治性高血压合并糖耐量减低,通过抗AT1受体自身抗体检测,有针对性选择降压药物缬沙坦且降压安全有效。
Objective To observe the antihypertensive effects of AT1 receptor antagonist with angiotensin Ⅱ (AngⅡ) on patients with refractory hypertension with impaired AT1 receptor autoantibodies and impaired glucose tolerance (IGT). Methods Serum anti-AT1 receptor autoantibodies were detected by ELISA in 237 patients, including 91 patients with refractory hypertension complicated by IGT (group A) and 106 patients with non-refractory hypertension with IGT (group B) , 40 healthy control group (for the C group). A group of AT1 receptor autoantibodies in 39 cases were A1 treatment group, 52 cases were negative for the A2 control group, both groups were given oral: nitrendipine 10mg / tid; hydrochlorothiazide 12.5mg / d; enteric aspirin Lin 100mg / d; valsartan 160mg / d; captopril 25mg / tid. 40 cases of normal control group. Results ① The positive rate of IGTAT1 receptor autoantibody in refractory hypertension was 57.1% (52/197), which was significantly higher than 15.1% in non-refractory hypertension with IGT and 12.5% in normal control group, with statistical significance . (2) The therapeutic effect of antihypertensive effect of refractory hypertension combined with impaired glucose tolerance in group A1 was significantly better than that in group A2, the two groups had significant statistical significance (P <0.05). ③ The evaluation of clinical antihypertensive effect, the total effective rate in group A1 was 84.6%, significantly higher than 51.9% in group A2, the two groups had a very significant significance (P <0.01). CONCLUSIONS: Refractory hypertension combined with impaired glucose tolerance is safe and effective with antihypertensive drug valsartan through anti-AT1 receptor autoantibodies.