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目的:探讨扩张型心肌病(DCM)的病因,观察针对抗心肌抗体采取免疫学治疗的临床疗效和预后。方法:对2001年1月～2005年12月入院治疗的DCM患者301例的病史、诊治过程、随访结果进行回顾性分析。结果:301例中病毒阳性185例(占61.46%),抗心肌抗体阳性207例(68.77%),病毒感染与抗心肌抗体具有显著相关性。随访时间0.6～5.5(2.1±1.6)年,抗心肌线粒体腺嘌呤核苷酸异位酶抗体(抗ANT抗体)阳性患者(A组)治疗后平均左室舒张末期内径(LVEDd)为(61.13±8.57)mm,LVEF为(42.65±11.45)%,平均心胸比(HTR)0.56±0.06;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(61.85±6.48)mm,LVEF(41.75±10.87)%,HTR0.56±0.02;抗ANT抗体和抗β1-受体抗体均阳性患者(C组)治疗后LVEDd(63.48±8.82)mm,LVEF(39.39±7.95)%,HTR0.57±0.08。3组与治疗前比较均差异有统计学意义(P<0.05)、NYHA心功能分级均改善Ⅰ～Ⅱ级。结论:病毒感染/自身免疫是DCM的常见致病因素,针对抗ANT抗体早期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,提高其生活质量。
Objective: To investigate the etiology of dilated cardiomyopathy (DCM) and to observe the clinical efficacy and prognosis of anti-myocardiac antibody immunotherapy. Methods: A retrospective analysis of 301 patients with DCM admitted to our hospital from January 2001 to December 2005 was conducted. Results: Among the 301 cases, 185 were positive (61.46%) and 207 were anti-myocardial antibodies (68.77%). The virus infection was significantly correlated with anti-myocardial antibodies. At follow-up from 0.6 to 5.5 years (2.1 ± 1.6) years, the average LV end-diastolic diameter (LVEDd) of anti-myocardial mitochondrial adenine nucleotide heteropelase (anti-ANT antibody) positive patients (A group) 8.57) mm, the mean LVEF was (42.65 ± 11.45)% and the average heart-thoracic ratio (HTR) was 0.56 ± 0.06; LVEDd was significantly higher in patients with positive anti-β1-adrenoceptor antibody 61.85 ± 6.48) mm, LVEF (41.75 ± 10.87)% and HTR0.56 ± 0.02 respectively. LVEDd (63.48 ± 8.82) mm and LVEF (39.39) were significantly higher in patients with anti-ANT and anti-β1- ± 7.95)% and HTR0.57 ± 0.08.3, respectively. There was significant difference between before and after treatment (P <0.05), NYHA functional class improved grade Ⅰ ~ Ⅱ. CONCLUSIONS: Viral infection / autoimmunity is a common risk factor for DCM. The early use of diltiazem against anti-ANT antibody and the use of metoprolol against DCM for anti-β1-receptor antibody significantly improved cardiac function and increased Quality of Life.