扩张型心肌病的病因分析与针对性治疗

Analysis of etiology and immunotherapy targeted autoantibody in patients with dilated cardiomyopathy

目的:探讨扩张型心肌病(DCM)的病因,观察针对抗心肌抗体采取免疫学治疗的临床疗效和预后。方法:对2001年1月～2005年12月入院治疗的DCM患者301例的病史、诊治过程、随访结果进行回顾性分析。结果:301例中病毒阳性185例(占61.46%),抗心肌抗体阳性207例(68.77%),病毒感染与抗心肌抗体具有显著相关性。随访时间0.6～5.5(2.1±1.6)年,抗心肌线粒体腺嘌呤核苷酸异位酶抗体(抗ANT抗体)阳性患者(A组)治疗后平均左室舒张末期内径(LVEDd)为(61.13±8.57)mm,LVEF为(42.65±11.45)%,平均心胸比(HTR)0.56±0.06;抗β1-肾上腺素能受体抗体(抗β1-受体抗体)阳性患者(B组)治疗后LVEDd(61.85±6.48)mm,LVEF(41.75±10.87)%,HTR0.56±0.02;抗ANT抗体和抗β1-受体抗体均阳性患者(C组)治疗后LVEDd(63.48±8.82)mm,LVEF(39.39±7.95)%,HTR0.57±0.08。3组与治疗前比较均差异有统计学意义(P<0.05)、NYHA心功能分级均改善Ⅰ～Ⅱ级。结论:病毒感染/自身免疫是DCM的常见致病因素,针对抗ANT抗体早期使用地尔硫和针对抗β1-受体抗体使用美托洛尔治疗DCM均可明显改善患者心脏功能,提高其生活质量。

Objective：To analysis the etiology of dilated cardiomyopathy （DCM） and observe the effects of the immunotherapy aimed at the anti-heart antibodies （AHA） on DCM as well as its prognosis. Method： A retrospective study of 301 patients hospitalized for DCM from January 2001 to December 2005 was performed in Union Hospital. The evaluation included medical history and results of the follow-up. Result：Virus was detected in 185 of 301 patients （61.46%） , meanwhile the anti-myocardial antibody was found in 207 patients（68.77%）. The virus was correlation to AHA. There were 46 of 301 patients（15.28%） who had the autoantibodies against adenine neuo- leotide traslocator （ANT）, treated with dilthiazem 90 mg daily and standard conventional therapy（group A）. There were 29 of 301（9.63%） patients who had the autoantibodies against β1- adrenoceptor, treated with metoprolol and standard conventional therapy（group B）,the patients with the autoantibodies against ANT and against β1- adrenoceptor were group C, after the median follow-up of （2.1 ±1.6） years, the patients gained one to two NYHA class, their ratio of coeur and thorax （HTR）, left ventricular end diastolic dimension（LVEDd） and left ventricular ejection fraction（LVEF） were significantly improved compared with prior treatment. Conclusion： Viral infection/autoimmunity was the common causes of DCM. The early immunotherapy with dilthiazem and metoprolol aimed directly at autoantibody against ANT and β1- adrenoceptor could obviously improve the cardiac function and quality of life of the patients with DCM.