舒张性心力衰竭抗β1受体自身抗体水平相关性研究

Research of autoantibodies against cardiac β1-adrenergic-receptorin patients with diastolic dysfunction after acute myocardial infarction

目的:研究急性心肌梗死(AMI)早期舒张性心力衰竭(DHF)患者血中抗β1受体自身抗体(β1-AR-Ab)的水平及其与预后的关系。方法:入选AMI早期DHF患者35例为DHF组,AMI心功能正常患者84例为对照组,入院后即刻抽血通过ELASA方法测定β1-AR-Ab的水平,根据β1-AR-Ab的水平分为β1-AR-Ab阳性组和阴性组,比较两组间β1-AR-Ab阳性率有无差异。出院后电话或门诊随访16个月,观察主要心血管不良事件(MACE),包括心绞痛、再发心肌梗死、因心力衰竭再住院、心源性死亡,根据MACE的发生分为MACE组和无MACE组,比较两组间β1-AR-Ab阳性率有无差异,同时对DHF组和对照组患者进行无事件率生存分析。结果:AMI早期DHF患者血中β1-AR-Ab水平明显高于对照组(48.6%vs.16.7%,P<0.05)。出院后随访,MACE组β1-AR-Ab水平与无MACE组比较差异无统计学意义(P>0.05),对DHF组与对照组进行生存分析显示对照组无事件率高于DHF组,存在统计学差异(P<0.05)。结论:AMI早期DHF患者β1-AR-Ab水平明显高于对照组患者,但β1-AR-Ab水平与AMI后MACE发生无明显相关。AMI早期DHF患者预后较心功能正常患者差。

Objective： To determine whether the autoantibodies against the cardiac β1-adrenergic re- ceptors（β1-AR-Ab） are related to diastolic heart failure （DHF） after acute myocardial infarction （AMI） and the relationship with prognosis. Methods ： 35 cases with DHF after AMI were DHF group, 85 cases with normal heart function after AMI were control group. Synthetic peptides corresponding to amino acids sequence of the second extracelluar loops of the β1-adrenergic-reeeptor were used as the antigens to detect the serum levels of autoantiboides from the patients AMI by means of enzyme linked immune assay. Patients were followed up 16 months after discharge in outpatient department or by telephone. Major adverse cardiac events（MACE） were re- corded including angina pectoris, being hospitalized by heart failure, recurrent myocardial infarction and sudden cardiac death. Results： The positive rates of serum autoantibodies for β1-adrenergic-reeeptor in DHF group （48.6%） were higher than control group（ 16. 7% ） （P 〈 0.05 ）. There is no significant difference of β1-AR-Ab positive rates in MACE group and non-MACE group（P 〉 O. 05）. Kaplan-Meier analysis revealed that the cumu- lative MACE event-free survival rate were lower in DHF group than which in control group（ P 〈 0. 05 ）. Conclu- sion ： The positive rates of serum autoantibodies for β1 -adrenergic-receptor in DHF after AMI is higher than that in control group. But there is no relationship between the level of β1-AR-Ab and MACE after AMI. The prog-nosis of DHF patients were worse than that with normal heart function.