心肌疾病抗ADP/ATP载体抗体与粒细胞-巨噬细胞集落刺激因子的临床研究

A clinical study of autoantibody against myocardiac adenine nucleotide translocator and granulocyte macrophage colony stimulating factor in children with myocardiac diseases

目的探讨病毒性心肌炎（ＶＭＣ）和扩张型心肌病（ＤＣＭ）的自身免疫发病机制。方法采用免疫印转和放射免疫技术检测了３０例ＶＭＣ、１４例ＤＣＭ患儿血浆中抗心肌线粒体ＡＤＰ／ＡＴＰ运载蛋白（ＡＮＴ）抗体和粒细胞－巨噬细胞集落刺激因子（ＧＭ－ＣＳＦ）。结果ＶＭＣ和ＤＣＭ患儿抗ＡＮＴ抗体和ＧＭ－ＣＳＦ的阳性率分别为７３％和５７％，而２５例正常健康儿分别为０和１２％（Ｐ均＜０．０１），且抗ＡＮＴ抗体与ＧＭ－ＣＳＦ的血浆水平呈正相关（ｒ＝０．４０９１，Ｐ＜０．０５）。结论小儿ＶＭＣ和ＤＣＭ的发病与心肌的自身免疫损伤有关，抗ＡＮＴ抗体和ＧＭ－ＣＳＦ均参与了这一过程。抗ＡＮＴ抗体可作为小儿ＶＭＣ和ＤＣＭ的一种特异性诊断指标。

Objective To explore the autoimmune pathogenic mechanisms responsible for viral myocarditis (VMC) and dilated cardiomyopathy (DCM). Methods The plasma autoantibody against myocardiac adenine nucleotide translocator (ANT) and granulocyte macrophage colony stimulating factor (GM CSF) in children (30 with VMC, 14 with DCM) were studied with western blot and radioimmunoassay. Results The plasma levels of anti ANT and GM CSF in patients of VMC and DCM groups were significantly higher than those in the healthy group (73% vs 0 for anti ANT, P <0.01; 57% vs 12% for GM CSF, P <0.01), and there was a significant correlation between the plasma levels of anti ANT and GM CSF ( r =0.4091, P <0.05). Conclusion Anti ANT and GM CSF both participate in the pathogenesis of VMC and DCM, and they are involved in the process of autoimmune injury of myocardium. Anti ANT can be taken as a specific marker for diagnosis of VMC and DCM in children.