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目的观察哌唑嗪联合缬沙坦治疗抗α1和AT1受体自身抗体阳性的糖尿病肾病合并难治性高血压的作用。方法以合成的α1和AT1受体多肽片段为抗原,应用ELISA技术,检测277例人血清抗α1和AT1受体自身抗体,其中糖尿病肾病合并难治性高血压120例(A组),糖尿病肾病合并非难治性高血压111例(B组),正常对照组46例(C组),A组中抗α1和AT1受体自身均阳性者71例(A1组),抗α1和AT1受体自身均阴性者49例(A2组),A1、A2两组均给予缬沙坦、哌唑嗪、尼群地平、双氯噻嗪、阿司匹林,分别观察它们的降压疗效。结果A组α1和AT1受体阳性率(55.8%、59.2%)与B组(27.9%、35.1%)、C组(7.5%、10.0%)比较具有统计学差异(P<0.01),哌唑嗪联合缬沙坦治疗后A1组降压疗效明显优于A2组(P<0.05),A1组临床疗效评定总有效率明显优于A2组(P<0.05)。结论糖尿病肾病合并难治性高血压患者,通过抗α和AT受体自身抗体检测,有针对性的选择降压药物哌唑嗪和缬沙坦,不但降压疗效好,而且安全。
Objective To observe the effect of prazosin and valsartan on the treatment of refractory hypertension in diabetic nephropathy with anti-α1 and AT1 receptor autoantibodies. Methods The anti-α1 and AT1 receptor autoantibodies of 277 human serum samples were detected by ELISA using the synthesized α1 and AT1 receptor peptide fragments as antigen. 120 cases of diabetic nephropathy with refractory hypertension (group A), diabetic nephropathy A total of 111 patients with non-refractory hypertension (group B) and 46 patients with normal control (group C), 71 patients (group A1) with anti-α1 and AT1 receptor positive in group A, 49 cases were negative (group A2), A1, A2 were given valsartan, prazosin, nitrendipine, bischlorothiazide, aspirin, respectively, to observe their antihypertensive effect. Results The positive rates of α1 and AT1 receptor in group A (55.8%, 59.2%) were significantly different from those in group B (27.9%, 35.1%) and group C (7.5%, 10.0% The effect of antihypertensive treatment in group A1 was better than that in group A2 (P <0.05). The total effective rate of clinical curative effect in group A1 was significantly better than that in group A2 (P <0.05). Conclusion Diabetic nephropathy patients with refractory hypertension, anti-α and AT receptor autoantibodies detection, targeted antihypertensive drugs prazosin and valsartan, not only antihypertensive effect is good, but also safe.