抗心肌抗体消长与病毒性心脏病转化关系探讨

Relationship between the rise and fall of antibodies against myocardium and the transformation of viral heart disease

目的:探讨抗心肌抗体消长与病毒性心脏病(VHD)病程的关系及在病毒性心肌炎(VMC)向扩张型心肌病(DCM)转化过程中所起的作用。方法:通过计算机预测ADP/ATP载体(ANT)、β1-受体、M2-胆碱能受体及肌球蛋白重链(MHC)抗原决定簇的氨基酸序列,用人工多肽合成仪合成的多肽作为抗原,应用ELISA方法,对不同病程的VHD患者进行抗心肌抗体的检测,同时对慢性VMC(CVMC)患者进行追踪观察及干预,并评价疗效。结果:随着VHD患者病程的延长,4种抗心肌抗体的检出率呈先升高后降低的趋势,CVMC和早期DCM患者抗心肌抗体阳性率最高;22例抗体阳性的CVMC患者经过3.1年随访,其中8例演变成为DCM,经给予相应药物干预治疗后6例恢复正常;而6例抗体阴性的患者随访期间均未出现DCM表现。结论:监测患者血清中抗心肌抗体有助于防止VMC向DCM转化,对DCM的早期诊断和干预及VHD的疗效判断和预后都可以提供重要的线索。

Objective:To study the relationship between the rise and fall of antibodies against myocardium and the course of viral heart disease and its transformation. Methods: We predicted amino acid sequences of determinants of myocardial antigens including the adenine nucleotide translocator (ANT), β2-adrenoceptor, M2-muscarin-ic receptor and myosin heavy chain (MHO with computer, synthesized peptides as antigens, examined antibodies in patients on different courses of viral heart disease by ELISA, the patients with chronic viral myocarditis were followgd up and intervened and then its effect was evaluated. Results: Along with the prolongation of the course of viral heart disease, the positive rate of antibodies showed a tendency of first increasing and then decreasing. The highest positive rate of antibodies was presented in patients with chronic viral myocarditis and during early stage of dilated cardiomyopathy. Eight of twenty two positive-antibody patients with chronic viral myocarditis transformed to dilated cardiomyopathy, 6 of them recovered after intervention with corresponding drugs, six negative-antibody patients did not manifested as dilated cardiomyopathy. Conclusion: Along with the prolongation of the course of viral heart disease, monitoring the positive rate of antibodies is helpful to avoid viral myocarditis transform to dilated cardiomyopathy, and can provide important clues for early diagnosis and intervention of dilated cardiomyopathy and for decteting the theraptic effect and the prognesis of the VHD.