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目的观察受体拮抗剂靶向治疗与常规治疗对糖尿病肾脏病减少蛋白尿的临床疗效。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271例糖尿病肾病患者血清抗β1和AT1受体自身抗体,根据检测结果分为受体自身抗体阳性组171例(阳性组中AT1、β1受体自身抗体均阳性者为靶向治疗组,71例)、受体自身抗体阴性组100例(阴性组中AT1和β1受体自身抗体均阴性者为常规治疗组,57例)和正常对照组40例。治疗组均给予酒石酸美托洛尔(metoprolol tartrate)、缬沙坦、非洛地平、双氯噻嗪、阿司匹林,治疗前后检测尿微量白蛋白和血压,分别观察靶向治疗和常规治疗对降压和减少尿微量白蛋白尿的疗效。结果 271例糖尿病肾病患者中受体自身抗体阳性率为63.1%(171/271),阴性率为36.9%(100/271),阳性率明显高阴性率,同样其阳性率明显高于正常对照组的12.5%(5/40),差异均有统计学意义(P<0.05)。靶向治疗组降压及减少蛋白尿疗效明显优于常规治疗组(P<0.01)。结论糖尿病肾脏病患者通过抗β1和AT1受体自身抗体检测,有针对性的酒石酸美托洛尔和缬沙坦受体拮抗剂靶向治疗,可提高降压及减少蛋白尿疗效且较安全。
Objective To observe the clinical effects of targeted therapy and conventional therapy of receptor antagonists on proteinuria of diabetic nephropathy. Methods The anti-β1 and AT1 receptor autoantibodies of 271 patients with diabetic nephropathy were detected by ELISA using the synthetic β1 and AT1 receptor peptide fragments as the antigen. According to the test results, they were divided into 171 autoantibody positive patients (positive group The AT1 and β1 receptor autoantibodies were all positive in the targeted therapy group (n = 71), and the autoantibody negative in the receptor group was 100 (negative AT1 and β1 receptor autoantibodies were negative in the conventional treatment group and 57 ) And normal control group of 40 cases. The patients in the treatment group were given metoprolol tartrate, valsartan, felodipine, diclofenac and aspirin, and urine microalbuminuria and blood pressure were measured before and after treatment. The effects of targeted therapy and routine treatment on the blood pressure And reduce the efficacy of urinary microalbuminuria. Results The positive rate of autoantibodies in patients with diabetic nephropathy was 63.1% (171/271), the negative rate was 36.9% (100/271), the positive rate was significantly high negative rate, and the positive rate was also significantly higher than that of the normal control group Of 12.5% (5/40), the differences were statistically significant (P <0.05). The efficacy of antihypertensive and proteinuria in the targeted therapy group was significantly better than that of the conventional therapy group (P <0.01). Conclusion Diabetic nephropathy patients with anti-β1 and AT1 receptor autoantibodies detection, targeted metoprolol tartrate and valsartan receptor antagonist targeted therapy can improve antihypertensive and reduce proteinuria efficacy and more secure.