大剂量丙种球蛋白对扩张型心肌病心衰患者心功能及免疫调节的疗效

Effects of large dose gamma globulin on cardiac function and immune regulation in patients with dilated cardiomyopathy and heart failure

目的:探讨大剂量丙种球蛋白对扩张型心肌病心力衰竭患者心功能及免疫调节的疗效。方法:90例扩张型心肌病心力衰竭患者按随机数字表法分为常规治疗组(45例),丙种球蛋白组(45例,在常规治疗基础上给予丙种球蛋白,400mg·kg-1·d-1静脉滴注,持续治疗5d),治疗3个月后,比较两组疗效及治疗前后心功能、心肌肌钙蛋白T(cTnT)、cTnI、N末端脑利钠肽前体(NT-proBNP)、抗心肌肌球蛋白重链自身IgG抗体(AMHCA IgG)滴度变化,并观察不良反应发生情况。结果:治疗3个月后丙种球蛋白组总有效率明显高于常规治疗组(80.00%比57.50%,P=0.02);治疗后与常规治疗组比较,丙种球蛋白组cTnT[(0.54±0.18)μg/L比(0.31±0.12)μg/L]、cTnI[(1.35±0.18)μg/L比(0.72±0.13)μg/L]、NT-proBNP[(758.34±64.28)pg/ml比(708.34±60.22)pg/ml]水平明显降低,左室射血分数[LVEF,(39.35±6.23)%比(47.32±6.10)%]明显提高(P均<0.05),治疗后丙种球蛋白组AMHCA IgG滴度显著低于治疗前及常规治疗组治疗后[(0.069±0.032)比(0.099±0.047)、(0.092±0.045),P均<0.05];丙种球蛋白组不良反应发生率明显高于常规治疗组(22.22%比6.67%,P=0.04),但症状较轻微,经对症处理后均好转。结论:大剂量丙种球蛋白可显著改善扩张型心肌病心力衰竭患者心功能,且降低心肌肌球蛋白重链自身IgG抗体滴度,具有良好的免疫调节作用。

Objective： To explore effects of large dose gamma globulin on cardiac function and immune regulation in patients with dilated cardiomyopathy （DCM） and heart failure （HF）. Methods： According to random number table, a total of 90 DCM ± HF patients were divided into routine treatment group （n= 45） and gamma globulin group （n = 45, received gamma globulin based on routine treatment, 400 mg kg^-1 d^-1 intravenous drip for 5d）. After three months, therapeutic effect, cardiac function, levels of cardiac troponin T （cTnT）, cTnI, N terminal pro brain na- triuretic peptide （NT-proBNP） and anti-cardiac myosin heavy chain auto-antibodies （AMHCA） IgG titer before and after treatment, incidence of adverse reactions were observed and compared between two groups. Results： After three-month treatment, total effective rate of gamma globulin group was significantly higher than that of routine treatment group （80. 00% vs. 57.50%, P = 0.02） t compared with routine treatment group after treatment, there were significant reductions in levels of cTnT [ （0. 54 ± 0.18） μg/L vs. （0. 31 ± 0.12） μg/L], cTnI [ （1.35 ± 0.18） μg/L vs. （0.72 ± 0.13） μg/L], NT-proBNP [ （758.34 ± 64.28） pg/ml vs. （708.34± 60.22） pg/ml], and significant rise in left ventricular ejection fraction [LVEF, （39.35 ± 6.23） % vs. （47. 32 ± 6. 10） %] in gamma globulin group, P〈0.05 all; compared with before treatment and routine treatment group after treatment, there was significant re- duction in AMHCA IgG titer [ （0. 099 ± 0. 047）, （0. 092 ± O. 045） vs. （0. 069 ± 0. 032）, P〈0. 05 both] in gamma globulin group; incidence rate of adverse reaction in gamma globulin group was significantly higher than that of rou- tine treatment group （22. 22% vs. 6.67%, P = 0.04）, but the symptoms were mild, and they recovered after symp- tomatic treatment. Conclusion. Large dose gamma globulin can significantly improve cardiac function and possesses good immune regulation effect in patients with dilated cardiomyopathy and heart failure.