【摘要】 目的:探讨扩张型心肌病(DCM)的发病机制,观察针对抗心肌抗体进行免疫学治疗的临床疗效和预后。方法:对2001年1月-2007年12月入院治疗的DCM患者(747例)的病史、诊治过程、随访情况进行回顾性分析。结果:747例中抗心肌抗体阳性者527例(70.55%),随访时间为0.9-7.2年,抗心肌线粒体ADP/ATP载体抗体阳性患者(A组)治疗后平均左室舒张末期内径(LVEDd)为(62.53±9.17)mm,左室射血分数(LVEF)为(37.65±11.15)%;抗β1-肾上腺素能受体抗体(抗β1-受体抗体)阳性患者(B组)治疗后LVEDd(61.35±5.68)mm,LVEF(40.65±12.78)%;抗ADP/ATP载体抗体和抗β1-受体抗体均阳性患者(C组)治疗后LVEDd(61.28±7.72)mm,LVEF(38.35±7.05)%。3组与治疗前比较LVEDd差异均有统计学意义(P<0.05)、NY-HA心功能分级均改善Ⅰ～Ⅱ级。结论:自身免疫是DCM的常见致病因素,针对抗ADP/ATP载体抗体使用地尔硫和针对抗β1-受体抗体使用美托洛尔治疗DCM均可明显改善患者心脏功能及心室重构,改善预后。更多还原

【Abstract】 Objective:To investigate the mechanism of dilated cardiomyopathy(DCM)and observe the effects and prognosis of the therapy aimed at the anti-heart antibodies(AHA)on DCM.Method:A retrospec-tive study of 747 patients hospitalized for DCM from January 2001 to December 2007 were performed in the First People’s Hospital of Yunnan Province.The evaluation included medical history、examination、treatment and results of the follow-up.Result:The anti-myocardial antibody was found in 527 patients(70.55%).There were 85 of 301 patients(28.24%)who had the autoantibodies against adenine neuoleotide traslocator(ANT),treated with dilthiazem 90 mg daily and standard conventional therapy(group A).There were 45 of 301(14.95%)patients who had the autoantibodies against β1-adrenoceptor,treated with metoprolol and standard conventional therapy(group B),the patients with the autoantibodies against ANT and against β1-adrenoceptor were group C,after the follow-up of 0.9-7.2 years,the patients gained one to two NYHA class,ification left ventricular end diastolic dimension(LVEDd)and left ventricular ejection fraction(LVEF)were significantly improved compared with prior treatment.Conclusion:Autoimmunity was the common cause of DCM.The early immunotherapy with dilthiazem and metoprolol aimed directly at autoantibody against ANT and β1-adrenoceptor could obviously improve the cardiac function and prevent ventricular remodeling of the patients with DCM as well as better prognosis.更多还原