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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。
Objective: To investigate the pathogenesis of dilated cardiomyopathy (DCM) and to observe the clinical efficacy and prognosis of anti-myocardial antibodies in immunological therapy. Methods: The history, diagnosis, treatment and follow-up of DCM patients (747 cases) admitted to hospital from January 2001 to December 2007 were analyzed retrospectively. Results: The mean left ventricular end-diastolic diameter (LVEDd) after anti-myocardial mitochondrial ADP / ATP carrier antibody-positive patients (A group) was 527 cases (70.55%) in 747 cases with follow-up time of 0.9-7.2 years (62.53 ± 9.17) mm, and the left ventricular ejection fraction (LVEF) was (37.65 ± 11.15)%. After treatment, the patients with anti-β1-adrenoceptor antibody (61.35 ± 5.68) mm and LVEF (40.65 ± 12.78)% respectively. LVEDd (61.28 ± 7.72) mm and LVEF (38.35 ± 7.05) were significantly higher in patients with anti-ADP / ATP carrier antibody and anti-β1- )%. There were significant differences in LVEDd between the three groups before treatment (P <0.05), and NY-HA functional class improved grade Ⅰ ~ Ⅱ. CONCLUSIONS: Autoimmunity is a common risk factor for DCM. Diltiazem for anti-ADP / ATP carrier antibodies and metoprolol for DCM for anti-β1-receptor antibodies significantly improved cardiac function and ventricular remodeling , Improve the prognosis.