病毒与抗心肌抗体在围生期心肌病发病中的作用

The role of virus and anti-heart antibodies in the pathogenesis of peripartum cardiomyopathy

目的:通过研究围生期心肌病(PPCM)患者的病因,探讨病毒与抗心肌抗体(AHA)在PPCM发病中的作用。方法:收集2010-03-2016-03在我院住院确诊为PPCM的女性患者32例,平均年龄(27.6±4.4)岁;其中NYHA心功能分级Ⅲ级者12例(37.5%)、Ⅳ级15例(46.8%)。采用逆转录聚合酶链式反应法(RT-PCR)检测以下病毒:柯萨奇病毒(CoxB-IgM)、埃可肠病毒(EVs-RNA)、巨细胞病毒(CMV-IgM);以酶联免疫吸附测定(ELISA)法检测血清AHA:抗心肌线粒体腺嘌呤核苷酸异位酶(ANT)抗体,抗β1-肾上腺素受体(β1-AR)抗体,抗M2-胆碱能受体(M2R)抗体,抗肌球蛋白重链(MHC)抗体;同时对患者病史、诊治过程、随访结果进行回顾性分析。结果:病毒检测为阳性者共22例(68.7%),其中CoxB-IgM阳性21例(65.6%)、EVs-RNA阳性19例(59.4%)、CMV-IgM阳性12例(37.5%)。AHA为阳性者共17例(53.1%),其中抗ANT抗体阳性15例(46.8%)、抗β1-AR阳性15例(46.8%)、抗M2R抗体阳性13例(40.6%)、抗MHC抗体阳性13例(40.6%)。病毒与AHA均阳性17例(53.1%)。32例患者中有高龄产妇9例(28.1%),经产妇13例(40.6%);经抗心力衰竭等治疗后28例(87.5%)患者获好转,NYHA分级改善Ⅰ~Ⅱ级。平均随访(26.7±12.4)个月,2例患者死亡。结论:病毒与AHA可能在PPCM的发病中起重要作用。

Objective：To clear the role of virus and anti-heart antibodies（AHA）in the pathogenesis of peripartum cardiomyopathy（PPCM）by analyzing the cause of this disease.Method：The clinical symptoms,results of laboratory examination,and prognosis of 32 female patients diagnosed of PPCM in our Hospital from March 2010 to March 2016 were studied,with the mean age of（27.6±4.4）years and NYHA with class Ⅲ in 12 patients（37.5%）,class Ⅳ in 15 patients（46.8%）.Coxasackie B virus（CoxB-IgM）,Enteric virus ribonucleic acid（EvsRNA）,cytomegalo virus（CMV-IgM）were detected by retrovirus transcription-polymerase chain reaction（RTPCR）.The ani-heart antibodies（AHA）,including anti-adenine nucleotide translocator（ANT）antibody,anti-β1-adrenocepter（β1-AR）antibody,anti-M2 muscarinic receptor（M2 R）antibody,and anti-myosin heavy chain（MHC）antibody are tested by Enzyme-linked immunoadsordent assay（ELISA）.Result：Virus were detected in 22 of 32（68.7%）patients,including CoxB-IgM（n=21,65.6%）,EVs-RNA（n=19,59.4%）,CMV-IgM（n=12,37.5%）.AHA were investigated in 17 of 32（53.1%）patients including anti-ANT antibody in 15（46.8%）patients,anti-β1-AR antibody in 15（46.8%）patients,anti-M2 R antibody in 13（40.6%）patients,and anti-MHC antibody in 13（40.6%）patients.Both of virus and AHA were detected positive in 17 of 32（53.1%）patients.Other causes included the old age during pregnancy（n=9,28.1%）,and multiple prior pregnancies（n=13,40.6%）in spite of virus and AHA.After medical therapy for heart failure,the cardiac function of 28（87.5%）patients improved as measured by NYHA classification.2（6.3%）patients died at a follow up of（26.7±12.4）months.Conclusion：Virus and AHA might play an important role in the pathogenesis of PPCM.