心肌梗死患者抗肌球蛋白轻链抗体检测的临床意义

CLINICAL SIGNIFICANCE OF ANTI-CARDIAC MYOSIN LIGHT CHAIN ANTIBODIES AFTER MYOCARDIAL INFARCTION

目的 :观察急性心肌梗死 (AMI)患者血清中是否存在抗心肌肌球蛋白轻链抗体 ,探讨该抗体与AMI患者心功能和预后的关系。方法 :6 7例AMI患者分别于发病第 1周末和 6个月进行免疫印迹法检测血清中的抗肌球蛋白轻链抗体和超声心动图检查 ,根据抗体结果分为抗体阳性组和阴性组 ,比较两组的心功能指标和预后。结果 :6 7例AMI患者血清抗肌球蛋白轻链抗体阳性有 17例 ,阳性率为 2 5 .4% ,30例健康对照均为阴性 ;抗体阳性组和阴性组的梗死部位和范围相似 ,但抗体阳性组Killip分级心功能明显差于抗体阴性组 (P <0 .0 5 ) ,而室壁运动减弱、室壁瘤形成和死亡率均明显高于阴性组 (P <0 .0 5 )。结论 :急性心肌梗死患者血清中可检测到抗肌球蛋白轻链的自身抗体 ,自身免疫反应可能参与心肌损伤和心室重构 ,影响心肌梗死患者的心功能和预后。

Objective:To study whether there were an anti-cardiac myosin light chain antibodies in sera of patients with myocardial infarction (AMI) and to understand the relationship between antibodies and the prognosis in patients with AMI.Methods:In 67 patients with acute AMI, anti myosin light chains antibodies were assayed by immunoblotting,left ventricular structure and cardiac function was examined by echocardiography at the end of the first week after infarction and during a 6-month follow-up. The patients with AMI were divided into antibodies-positive group and antibodies-negative group. Left ventricular end-diastolic function and prognosis were compared between the two groups.Results:The antibodies were positive in 17 patients with AMI, with apositive rate of 25.4%, while they were negative in 30 health donors. The locations of myocardial infarction in the two groups were similar. There were significant differences in Killip class I (P<0.05),decreasing of wall motion and ventricular aneurysm, between the positive group and the negative group. During a 6-month follow-up, the mortality was higher in antibodies positive group than that of in antibodies negative group (P<0.05).Conclusions: It is concluded that anti myosin light chains antibodies can be detected in serum of patients with AMI.Autoimmunity might play a role in cardiac impairment and ventricular remodeling and associate with cardiac function and prognosis of AMI.