大剂量丙种球蛋白对扩张型心肌病心衰患者心肌肌凝蛋白重链自身IgG抗体滴度的影响

Influence of large dose γ globulin on myocardial cardiac myosin heavy chain own IgG antibody titer in patients with dilated cardiomyopathy heart failure

目的：探究大剂量丙种球蛋白对扩张型心肌病（DCM）心力衰竭患者心肌肌凝蛋白重链（CMHC）自身免疫球蛋白G（IgG）抗体滴度和临床疗效的影响。方法：选择2011年3月~2014年5月我院心内科收治的DCM心力衰竭患者160例。按照随机数字表法,患者被随机均分分为常规治疗组（80例）和丙种球蛋白组（80例,在常规治疗组基础上接受大剂量丙种球蛋白治疗）。观察比较两组患者治疗前后的心功能指标,IgG抗体滴度以及血清心肌肌钙蛋白T（cTnT）和cTnI水平。结果：与治疗前比较,治疗6个月后丙种球蛋白组左室舒张末期内径[LVEDd,（67.50±5.50）mm比（56.50±2.50）mm]和左室收缩末期内径[LVESd,（55.50±6.80）mm比（43.50±2.30）mm]显著降低,左室射血分数[LVEF,（33.50±3.50）%比（53.50±8.50）%]显著升高,而常规治疗组仅LVEF[（32.80±4.20）%比（41.50±5.50）%]显著升高,P均〈0.05;与常规治疗组比较,治疗6个月后丙种球蛋白组的LVEDd[（63.50±2.50）mm比（56.50±2.50）mm]和LVESd[（51.60±4.80）mm比（43.50±2.30）mm]显著降低,LVEF显著升高,P均〈0.05。治疗1、3、5和6个月后,丙种球蛋白组IgG抗体滴度显著降低,且均显著低于同期常规治疗组的（P均〈0.05）。治疗6个月后两组cTnT和cTnI水平均较治疗前显著减低（P均〈0.05）,且与常规治疗组比较,丙种球蛋白组cTnT[（0.55±0.10）μg/L比（0.26±0.02）μg/L]和cTnI水平[（1.20±0.40）μg/L比（0.60±0.10）μg/L]下降更显著（P均〈0.05）。结论：大剂量丙种球蛋白治疗扩张型心肌病心力衰竭患者,能够显著改善患者的心肌功能,明显降低心肌肌凝蛋白重链自身IgG抗体水平,显著降低血清肌钙蛋白T和I的含量,值得在临床上推广。

Objective.. To explore influence of large dose , globulin on myocardial cardiac myosin heavy chain （CM- HC） own IgG antibody titer and therapeutic effect in patients with dilated cardiomyopathy （DCM） heart failure （HF）. Methods： A total of 160 DCM ＋ HF patients hospitalized in our department of cardiology from Mar 2011 toMay 2014 were selected. According to random number table, they were randomly and equally divided into routine treatment group （n = 80, RT group） and ）＇ globulin group （n = 80, received large dose ） globulin therapy based on RT group）. Cardiac function indexes, IgG antibody titer and serum levels of cTnT and cTnI were observed and com- pared between two groups before and after treatment. Results： Compared with before treatment after six- month treatment, there were significant reductions in LVEDd [ （67.50 ± 5.50） mm vs. （56.50 ±2.50） mm] and LVESd [ （55.50±6.80） mm vs. （43.50±2.30） mm], and significant rise in LVEF [ （33.50±3.50）% vs. （53.50±8.50） %] in y globulin group, and only LVEF significantly rose [ （32.80±4. 20） % vs. （41.50±5.50） %] in RT group, P〈0.05 all; compared with RT group after six- month treatment, there were significant reductions in LVEDd [ （63.50 ± 2.50） mm vs. （56.50 ± 2.50） mini and LVESd [ （51.60 ± 4.80） mm vs. （43.50 ± 2.30） mm], and significant rise in LVEF in 7 globulin group, P〈0.05 all. On one, three, five and six months after treatment, IgG antibody titer significantly reduced in 7 globulin group and they were significantly lower than those of RT group （P〈0. 05 all）. After six- month treatment, cTnT and cTnI levels of both groups were significantly lower than those of before treatment （P〈0.05 all）, compared with RT group, there were significant reductions in cTnT [- （0.55±0.10） μg/L vs. （0.26±0.02） μg/L] and cTnI levels [ （1.20 ± 0.40） μg/L vs. （0.60 ± 0.10） μg/L] in 7 globulin group, P〈0.05 both. Conclusion.. Large dose 7 globulin can significantly improve myocardial function, re- duce myocardial CMHC own IgG antibody level and serum concentrations of cTnT and cTnI in DCM ＋ HF pa- tients, so it＇ s worth extending.