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目的探讨2型糖尿病患者α1肾上腺素能受体(α1R)和血管紧张素Ⅱ1型受体(AT1R)自身抗体与冠状动脉性心脏病(冠心病)的关系。方法随机选择2001-01-2007-01广州军区武汉总医院内分泌科及华中科技大学附属协和医院心内科收治的2型糖尿病住院患者371例,分为2型糖尿病伴冠心病组117例[无症状心肌缺血77例,稳定性心绞痛31例,陈旧性心肌梗死(OMI)9例],2型糖尿病不伴冠心病组254例。40例为正常对照组(来自本院体检中心)。以合成的α1R和AT1R多肽片段为抗原,应用酶联免疫吸附测定(ELISA)技术,检测上述患者血清中抗α1R和AT1R自身抗体。24h尿白蛋白排泄率(UAER)亦用酶联免疫吸附法(ELISA)测定技术检测。用超声心动图检查评价心脏结构和功能。多元Logistic回归分析2型糖尿病伴冠心病的影响因素。结果 2型糖尿病患者抗α1R和AT1R自身抗体阳性率高于正常对照组(52%比10%,48%比13%),差异有统计学意义(P<0.01);2型糖尿病伴冠心病组抗α1R和AT1R自身抗体阳性率明显高于2型糖尿病不伴冠心病组(65%比44%,67%比39%,均P<0.01)。无症状心肌缺血组α1R自身抗体阳性率明显高于稳定性心绞痛组及OMI组(74%比45%、67%,均P<0.05),稳定性心绞痛组AT1R自身抗体阳性率明显高于无症状心肌缺血组及OMI组(84%比64%、44%,均P<0.05)。多元Logistic回归分析显示,2型糖尿病伴冠心病发生的危险因素是收缩压(OR1.769,95%CI0.737～0.973)、抗α1R自身抗体阳性(OR1.537,95%CI1.325～1.886)及抗AT1R自身抗体阳性(OR2.017,95%CI2.013～2.019)。结论 2型糖尿病伴冠心病可能与血清α1R和AT1R自身抗体有关。
Objective To investigate the relationship between α1 adrenergic receptor (α1R) and angiotensin Ⅱ type 1 receptor (AT1R) autoantibodies and coronary heart disease (CHD) in type 2 diabetic patients. Methods A total of 371 hospitalized patients with type 2 diabetes admitted to the Department of Endocrinology, Wuhan General Hospital of Wuhan Military Command and Union Hospital, Huazhong University of Science and Technology from January 2001 to July 2007 were randomly divided into two groups: type 2 diabetes with coronary heart disease in 117 patients [asymptomatic 77 cases of myocardial ischemia, 31 cases of stable angina, 9 cases of old myocardial infarction (OMI)], and 254 cases of type 2 diabetes without coronary heart disease. 40 cases of normal control group (from our hospital physical examination center). The anti-α1R and AT1R autoantibodies were detected in sera of patients with synthetic α1R and AT1R polypeptide fragments by enzyme-linked immunosorbent assay (ELISA). 24h urinary albumin excretion rate (UAER) was also detected by enzyme-linked immunosorbent assay (ELISA) technique. Echocardiography was used to assess cardiac structure and function. Influential Factors of Type 2 Diabetes with Coronary Heart Disease by Multivariate Logistic Regression. Results The positive rates of anti-α1R and AT1R autoantibodies in type 2 diabetic patients were significantly higher than those in normal controls (52% vs 10%, 48% vs 13%, respectively) (P <0.01); type 2 diabetes with coronary heart disease The positive rates of anti-α1R and AT1R autoantibodies were significantly higher than those in patients with type 2 diabetes without coronary heart disease (65% vs 44%, 67% vs 39%, both P <0.01). The positive rate of α1R autoantibodies in asymptomatic myocardial ischemia group was significantly higher than that in stable angina pectoris group and OMI group (74% vs 45%, 67%, both P <0.05). The positive rate of AT1R autoantibodies in stable angina pectoris group was significantly higher than that in stable angina pectoris group Symptoms of myocardial ischemia and OMI group (84% vs 64%, 44%, both P <0.05). Multivariate logistic regression analysis showed that the risk factors for type 2 diabetes with coronary heart disease were systolic blood pressure (OR1.769, 95% CI 0.737-0.973) and anti-α1R autoantibodies (OR1.537, 95% CI 1.325-1.886 ) And anti-AT1R autoantibodies (OR2.017, 95% CI 2.013 ~ 2.019). Conclusion Type 2 diabetes with coronary heart disease may be related to serum auto-antibodies of α1R and AT1R.