心肌病变患者自身免疫反应的临床分析

Clinical analysis of autoimmune response in patients with myocardial disease

目的:观察抗心肌抗体(Anti-myocardial antibody,AMA)在心肌病变者中存在的比例,探讨自身免疫反应与心肌损伤的病情及病程的关系。方法:选择有心脏损害患者192例,其中病毒性心肌炎(Viral myocarditis,VMC)44例(9例为急性重症型),扩张型心肌病(Dilated cardiomyopathy,DCM)38例,风湿性心脏病(Rheumatic heart disease,RHD)40例(10例有风湿活动),系统性红斑狼疮(Systemic lupus erythematosus,SLE)30例,冠心病(Coronary heart disease,CHD)40例,采用间接免疫荧光法检测192份血清样本的AMA。结果:VMC、DCM、RHD、SLE、CHD患者血清中AMA阳性率分别为27.3%、23.7%、17.5%、16.7%、2.5%;重症VMC患者AMA阳性率与其他类型VMC患者阳性率比较,差异无统计学意义;有风湿活动的风心病患者A-MA阳性率与无风湿活动的风心病患者阳性率比较,差异无统计学意义。结论:这几种心肌病变与自身免疫反应密切相关,检测AMA既可了解心肌的损伤情况,又可以指导临床治疗。

Objective：To calculate the rates of anti-myocardial antibody（AMA） in the patients with myocardial disease and to ex- plore the relationship between autoimmune response and myocardial injury. Methods ：Totally 192 cases of cardiac damage were en- rolled in the study,including 44 cases of viral myocarditis （VMC）, among which 9 cases were severe acute myocarditis, 38 cases of di- lated cardiomyopathy（DCM）,40 cases of rheumatic heart disease （RHD）,among which 10 cases had active rheumatism,30 cases of systemic lupus erythematosus （SLE） and 40 cases of coronary heart disease （CHD）. Anti-myocardial antibodies of these serum sam- ples were detected by indirect immunofluorescence assay. Results：The positive rates of anti-myocardial antibody in VMC, DCM, RHD, SLE and CHD group were 27.3%,23.7%, 17.5%, 16.7% and 2.5% respectively. There was no statistical significance between patients with serious acute virus myocarditis and other types of virus myocarditis. There was no significant difference in positive anti- myocardial antibody between RHD patients with active rheumastism and those without active rheumatism. Conclusions：Myocardial diseases are correlated with autoimmune response. Detecting the antimyocardial antibody in serum of patients could not only help to know the degree of myocardial injury but also guide the clinical treatment.