心脏β_1肾上腺素能受体和M_2乙酰胆碱能受体的自身抗体与肥厚型心肌病的关系研究

Correlation Study Between Autoantibodies to Myocardium β_1-adrenergic Receptor,M_2-muscarinic Receptor and Hypertrophic Cardiomyopathy

目的:探讨心脏β_1肾上腺素能受体和M_2乙酰胆碱能受体的自身抗体与肥厚型心肌病的相关性。方法:以细胞外第二环表位肽段的合成肽作为抗原,应用酶联免疫吸附技术,检测81例肥厚型心肌病患者(肥厚型心肌病组)和50例健康受试者(正常对照组)血清中心脏β_1肾上腺素能受体和M_2乙酰胆碱能受体的自身抗体。结果:(1)肥厚型心肌病组β_1受体自身抗体的阳性率为58.02%(47/81),明显高于正常对照组12.00%(6/50),差异有统计学意义(P<0.05);肥厚型心肌病组M_2乙酰胆碱能受体自身抗体阳性率为44.44%(36/81),显著高于正常对照组10.00%(5/50),差异有统计学意义(P<0.05)。(2)肥厚型心肌病组β_1肾上腺素能受体和M_2乙酰胆碱能受体的自身抗体的平均几何滴度分别为1:85和1:80,显著高于正常对照组的1:36和1:35,差异有统计学意义(P<0.05)。(3)肥厚型心肌病组β_1肾上腺素能受体自身抗体阳性血清中43.48%(20/46)的患者同时具有M_2乙酰胆碱能受体的自身抗体。结论:肥厚型心肌病患者血清中存在心脏β_1肾上腺素能受体和M_2乙酰胆碱能受体的自身抗体,可能与其心肌结构变化和舒张功能下降有关。心脏β_1肾上腺素能受体和M_2乙酰胆碱能受体的双抗体阳性可能是自身免疫反应的多重性表现,提示免疫学机制参与肥厚型心肌病的病理生理过程。

Objective：To study the relationship between autoantibodies to myocardiumβ1-adrenergic receptor（β1-receptor）,M2-muscarinic receptor（M2-receptor）and hypertrophic cardiomyopathy（HCM）in relevant patients.Methods：Our research included in 2 groups：HCM group,n=81 patients and Control group,n=50 normal subjects.Synthetic peptides corresponding to amino acid sequence of second extracellular loops ofβ1-receptor and M2-receptor were used as antigens,ELISA was conducted to detect serum autoantibodies toβ1-receptor and M2-receptor in both groups.Results：（1）Compared with Control group,HCM group had the higher positive rates of autoantibodies as forβ1-receptor was 58.02%（47/81）vs 12.00%（6/50）and for M2-receptor was 44.44%（36/81）vs 10.00%（5/50）,both P〈0.05.（2）Compared with Control group,HCM group had the higher mean geometric titers of autoantibodies as forβ1-receptor was 1：85 vs 1：36and for M2-receptor was 1：80 vs 1：35,both P〈0.05.（3）In HCM group,43.48%patients with positive autoantibody toβ1-receptor meanwhile have autoantibody to M2-receptor.Conclusion：HCM patients having both autoantibodies toβ1-receptor and M2-receptor might be related to cardiac structure change and diastolic function decreasing.Both positive antibodies implies that immunological mechanism has been involved in pathophysiological process in HCM patients.