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目的探讨抗G蛋白偶联β1肾上腺素能受体自身抗体致病作用及临床干预。方法以合成的β1受体多肽片段为抗原,应用酶联免疫吸附测定(ELISA)技术,检测171例人血清中抗G蛋白偶联β1受体自身抗体,其中糖尿病心肌病患者71例,2型糖尿病60例及正常对照组40例。对糖尿病心肌病受体自身抗体阳性的为治疗组,阴性的为对照组,两组均在常规强心利尿基础上给予缬沙坦80mg,po,qd;硝酸异山梨醇酯(isosorbide dinitrate)10mg,po,tid;酒石酸美托洛尔(metororolol tartrate)25mg po,bid;双氯噻嗪12.5mgpo,qd;阿斯匹林100mg po,qd,分别观察阳性组和阴性组对心功能的影响,6~12个月采用超声心动图进行对比观察。结果糖尿病心肌病组抗β1受体阳性率为57.7%(41/71),明显高于糖尿病无心肌病组18.3%(11/60)及正常对照组17.5%(7/40),比较具有统计学意义(P<0.01)。阳性组反映左室形态、收缩、舒张功能的指标明显改善(P<0.05),阳性组优于阴性组,阳性组总有效率为82.9%,阴性组56.7%。结论免疫学机制可能参与糖尿病心肌病病理生理过程;酒石酸美托洛尔可明显改善心功能。
Objective To investigate the pathogenicity of anti-G protein-coupled β1 adrenergic receptor autoantibodies and clinical intervention. Methods The anti-G protein-coupled β1 receptor autoantibodies were detected in 171 human serum samples by enzyme-linked immunosorbent assay (ELISA) using the synthetic β1 receptor peptide fragment as an antigen. Among them, 71 patients with diabetic cardiomyopathy, 2 type 60 cases of diabetes mellitus and 40 cases of normal control group. Anti-diabetic cardiomyopathy autoantibodies positive for the treatment group, negative for the control group, both groups were given conventional valsartan on the basis of valsartan 80mg, po, qd; isosorbide dinitrate (isosorbide dinitrate) 10mg , po, tid; metorolol tartrate 25mg po, bid; diclofenac 12.5mgpo, qd; aspirin 100mg po, qd, were observed positive group and negative group on the cardiac function, 6 to 12 months by echocardiography comparative observation. Results The positive rate of anti-β1 receptor in diabetic cardiomyopathy group was 57.7% (41/71), significantly higher than that in diabetic cardiomyopathy group (18.3%, 11/60) and normal control group (17.5%, 7/40) Significance (P <0.01). In the positive group, the indicators of left ventricular morphology, systolic and diastolic function were significantly improved (P <0.05). The positive group was better than the negative group, the total effective rate was 82.9% in the positive group and 56.7% in the negative group. Conclusion Immunological mechanism may be involved in the pathophysiology of diabetic cardiomyopathy; metoprolol tartrate significantly improves cardiac function.