系列抗心肌多肽自身抗体对扩张型心肌病的诊断价值

目的 :探讨抗人工合成多肽自身抗体在扩张型心肌病 ( DCM)诊断中的价值。方法 :根据计算机预测心肌 ADP/ ATP载体 ( ANT)、β1 受体、M2 受体和肌球蛋白重链 ( MHC)抗原决定簇的氨基酸序列并合成多肽片段 ,以此片段作为抗原 ,同时用天然抗原对比 ,以酶联免疫吸附方法检测 48例 DCM患者 ( DCM组 )和 48例健康献血员 (对照组 )血清中抗心肌多肽自身抗体。结果 :DCM组中抗 ANT抗体、抗 β1 受体抗体、抗 M2 受体抗体和抗MHC抗体阳性分别有 31、2 6、2 0和 2 3例 ,与对照组比较有显著性差异 ( P <0 .0 0 5 ) ,且与天然心肌抗原检测结果高度一致 ( P <0 .0 1)。结论 :人工合成多肽可代替天然心肌抗原用于检测抗心肌自身抗体 ,抗心肌多肽抗体检测可以作为 DCM免疫学诊断方法     

高血压合并肾损害患者血清抗AT1、α1、β1和M2受体自身抗体的分析

目的探讨抗血管紧张素Ⅱ受体1型(AT1)受体,α1-肾上腺素受体(α1-受体)、M2胆碱能受体(M2-受体)、β1肾上腺素受体(β1-受体)自身抗体是否与高血压病合并肾损害有关.方法以合成的β1、M2、AT1、α1受体多肽片段为抗原,应用酶联免疫吸附测定(ELISA)技术,检测56例高血压合并肾损害患者和58例高血压无肾损患者及40例正常人血清中抗G-蛋白偶联型β1、M2、AT1、α1受体自身抗体.结果高血压病并肾损害组抗β1、M2、AT1、α1受体抗体阳性率分别为67.9%、46.4%、46.4%、46.4%,明显高于高血压无肾损害组的19%、20.7%、15.5%、12.1%和高于正常对照组10%、12.5%、17.5%和15%(P＜0.01).结论抗G-蛋白偶联型受体自身抗体可能与高血压合并肾损害发病有关.     

慢性肝病与β2糖蛋白Ⅰ抗体及其他自身抗体的关系

目的　研究 β2 糖蛋白Ⅰ (β2 GPⅠ )抗体及抗双链DNA抗体 (ds DNA)、抗平滑肌抗体(SMA)、抗核糖核蛋白抗体 (RNPA)与慢性肝病的相关性。方法　选择明确诊断的慢性乙型肝炎和乙型肝炎后肝硬化患者为研究对象 ,采用ELISA法 ,以纯化的人 β2 GPⅠ为抗原 ,检测这些患者血清中β2 GPⅠ抗体水平 ,同时检测ds DNA、SMA、RNPA的血清水平。结果　乙型肝炎后肝硬化患者血清中β2 GPⅠ抗体水平与对照组相比明显升高 (P <0 .0 1) ,患者血清中 β2 GPⅠ抗体高于慢性乙型肝炎组 (P <0 .0 5 ) ;并且发现慢性乙型肝病患者 β2 GPⅠ抗体的阳性率高于其他自身抗体。结论　乙型肝炎病毒(HBV)感染与 β2 GPⅠ抗体的产生可能相关 ,推测 β2 GPⅠ参与HBV感染的病理过程。     

甲状腺激素对慢性心力衰竭患者外周血淋巴细胞β肾上腺素能受体密度的影响

目的 :探讨甲状腺激素 (TH)对慢性充血性心力衰竭 (CHF)患者外周血淋巴细胞 β肾上腺素能受体(β受体 )密度的影响。 方法 :2 8例扩张型心肌病 (DCM)及特发性心肌病 (ICM)所致的CHF患者随机分为A及B组 (各 14例 ) ,B组在A组常规抗心力衰竭治疗基础上加服左甲状腺激素钠 (优甲乐 5 0 ,L T50 ) 1个月 ,治疗前后 ,采用放射免疫法测定血清TH水平、同位素放射配基法测定外周血淋巴细胞 β受体密度 ,并与 8例正常人对照。 结果 :CHF患者淋巴细胞 β受体及血清TH密度低于对照者 ,治疗 1个月后 ,B组较A组血清TH水平明显增高 (P<0 .0 1) ,外周血淋巴细胞 β受体增加 (P <0 .0 5 ) ,外周血淋巴细胞 β受体变化与血清TH水平呈正相关。 结论 :TH增加DCM和ICM所致CHF患者血清TH水平 ,上调其外周血淋巴细胞 β受体密度     

扩张型心肌病与抗G-蛋白偶联受体的自身抗体

目的　探讨抗G 蛋白偶联型 β2 、α1和血管紧张素Ⅱ受体 1型 (AT1受体 )的自身抗体是否与扩张型心肌病的发病有关。方法　以细胞外第二环表位肽段的合成肽作为抗原 ,应用酶联免疫吸附测定 (ELISA)技术 ,检测 86例扩张型心肌病患者和 6 1例正常人血清中抗G 蛋白偶联型 β2 、α1和AT1受体的自身抗体。结果　 (1)扩张型心肌病组抗G 蛋白偶联型 β2 、α1和AT1受体自身抗体的阳性率分别为 4 4 2 %、4 5 3%和 4 0 7% ,明显高于正常组的 11 5 %、9 8%和 14 8% (P <0 0 1) ;(2 )扩张型心肌病组自身抗体阳性患者的抗体滴度分别为 1∶136、1∶12 4、1∶12 6 ,明显高于正常组的 1∶4 6、1∶32、1∶2 8(P <0 0 1) ;(3)扩张型心肌病组 β2 受体自身抗体阳性患者血清中 ,6 5 8%的患者同时具有α1受体的自身抗体 ;71 1%的患者同时具有AT1受体的自身抗体 ;4 7 4 %的患者同时具有上述 3种受体的自身抗体。结论　扩张型心肌病患者血清中不仅存在抗G 蛋白偶联型 β2 、α1和AT1受体的自身抗体 ,而且抗体滴度也明显高于正常对照组。约 5 0 %的扩张型心肌病患者同时具有上述 3种受体的自身抗体。提示免疫学机制可能参与扩张型心肌病的病理生理过程 ,参与机理有待进一步深入研究     

扩张型心肌病患者血清β1肾上腺素能受体自身抗体水平与左室舒张末期容积相关

1989年Limas首次提出扩张型心肌病(DCM)患者的血清中有抗β1肾上腺素受体(antilβ-AR)自身抗体存在[1].研究表明β1-AR自身抗体在DCM的致病机制中发挥重要作用.本研究对于抗β1-AR自身抗体水平及左室舒张末期容积(LVEDV)的关系进行了分析.     

高血压合并肾损害患者血清抗β1和α1受体自身抗体与血清肌酐水平的相互性分析

目的探讨高血压合并肾损害患者血清β1肾上腺素受体(β1受体)和α1胆碱能受体(α1受体)自身抗体与血清肌酐水平的关系.方法以合成的α1受体和β1受体多肽片段为抗原,应用酶联免疫吸附测定(ELISA)技术检测了118例(高血压并肾损害60例,高血压无肾损害58例,正常对照40例).结果高血压病并肾损害组抗β1和α1受体自身抗体阳性率分别为(67.9%、46.4%)明显高于高血压无肾损害组的19%和20.7%及正常对照组17.5%和15%(P<0.01).结论抗G-蛋白偶联型受体自身抗体可能与高血压合并肾损害有关,与血清肌酐水平有关.     

心力衰竭患者与心脏β2、α1肾上腺素能受体和血管紧张素Ⅱ1型受体的自身抗体

目的　本研究检测不同心脏病所致的慢性心力衰竭 (心衰 )患者 β2 、α1 肾上腺素能受体和血管紧张素Ⅱ 1型 (AT1 )受体的自身抗体 ,探讨心功能发生病理变化时 ,上述三种自身抗体的产生与疾病的相关性。方法　以细胞外第二环表位肽段的合成肽作为抗原 ,应用酶联免疫吸附测定(ELISA)技术 ,随机检测 2 67例受试者血清中 β2 、α1 和AT1 受体的自身抗体。心衰组为 2 0 6例不同心脏病的心衰患者 ,其中缺血性心肌病 63例、扩张型心肌病 86例、高血压病 57例。正常组为 61例正常人作对照。结果　 (1 )心衰组 β2 、α1 和AT1 受体的自身抗体阳性分别为 46 1 % (95/ 2 0 6)、48 5 % (1 0 0 /2 0 6)和 46 6 % (96/ 2 0 6) ,明显高于正常组的 8 2 % (5/ 61 )、9 8% (6/ 61 )和 1 3 1 % (8/ 61 ) ,P <0 0 1 ;(2 )心衰组自身抗体阳性患者的抗体滴度分别为 1∶89、1∶98和 1∶96 ,明显高于正常组的 1∶35、1∶32和 1∶31 ,P <0 0 1 ;(3)心衰组 β2 受体自身抗体阳性者 95例中 ,有 60例 (63 2 % )患者同时具有α1 受体的自身抗体 ,有 64例 (67 4% )患者同时具有AT1 受体的自身抗体 ,有 51例 (53 7% )的患者同时具有上述三种受体的自身抗体阳性。结论　β2 、α1 和AT1 受体的自身抗体不仅存在于多种心脏病心衰患者     

扩张型心肌病与心肌自身抗体的研究进展

近年来,随着免疫学、病毒学、分子生物学理论与技术的发展,抗心肌抗体与扩张型心肌病（DCM）的关系越来越受重视。抗心肌抗体的产生和参与DCM的资料累积已近50年。例如抗β肾上腺能受体抗体、抗ATP/ADP运载蛋白抗体、抗M胆碱能受体抗体和抗肌球蛋白重链抗体等,均可激活机体免疫系统使心肌细胞肿胀和坏死,是心脏受累的重要指标。本文主要对DCM与心肌自身抗体的相关发病机制作一综述。     

高血压合并肾损害患者血清抗β1和α1受体自身抗体与血清肌酐水平的相互性分析

目的探讨高血压合并肾损害患者血清β1肾上腺素受体(β1受体)和α1胆碱能受体(α1受体)自身抗体与血清肌酐水平的关系。方法以合成的α1受体和β1受体多肽片段为抗原,应用酶联免疫吸附测定(ELISA)技术检测了118例(高血压并肾损害60例,高血压无肾损害58例,正常对照40例)。结果高血压病并肾损害组抗β1和α1受体自身抗体阳性率分别为(67·9%、46·4%)明显高于高血压无肾损害组的19%和20·7%及正常对照组17·5%和15%(P<0·01)。结论抗G-蛋白偶联型受体自身抗体可能与高血压合并肾损害有关,与血清肌酐水平有关。     

高血压患者抗α1肾上腺素受体抗体与心脏重构的临床观察

目的 观察抗α1肾上腺素受体抗体（简称α1受体抗体）对高血压患者心室重构的影响。方法 采用酶联免疫吸附法（ELISA）对553例高血压患者进行血清抗仅．受体抗体检测并记录所有患者的超声心动图检查结果。运用多元logistic回归分析高血压患者左心室扩大的影响因素。结果 553例高血压患者血清抗α1受体抗体阳性率为32．3％（179／553）。抗α1受体抗体阳性组中左心房扩大占的比例明显高于阴性组（分别为53．6％,44．3％,P〈0．05）;阳性组中左心室扩大所占比例也明显高于阴性组（分别为12．8％,6．1％,P〈0．01）。多元logistic回归共筛选出4个左心室扩大的危险因素：男性、病程、心率、血清抗α1受体抗体（P均〈0．05）。结论 抗α1受体抗体与高血压患者左心室扩大有关,该抗体阳性可能对预测高血压患者左心室重构具有重要意义。     

心脏β1和M2受体自身抗体与心力衰竭的研究

目的：探讨心力衰竭（心衰）患者心脏β1和M2受体自身抗体的产生与疾病发生、发展的相关性。方法：以细胞外第二环表位肽段的合成肽作为抗原,应用酶联免疫吸附测定技术,检测265例受试者血清中心脏β1和M2受体的自身抗体。结果：心衰组β1受体自身抗体的阳性率为45．7％（86／188）,明显高于单纯高血压组和对照组的10．4％（8／77）,P＜0．01;心衰组M2受体自身抗体的阳性率为52．7％（99／188）,明显高于单纯高血压组和对照组的11．7％（9／77）,P＜0．01;心功能Ⅱ-Ⅲ级的阳性率及抗体滴度明显高于Ⅳ级;心衰组β1受体自身抗体阳性血清中高达56．1％的患者同时具有M2受体的自身抗体。结论：心脏β1和M2受体自身抗体存在于多种心脏病心衰患者的血清中,可能与心衰时心肌结构变化和功能下降有关,与原发心脏病无明显因果关系;心脏β1和M2受体的双抗体阳性可能是自身免疫反应的多重性表现,提示免疫学机制参与心衰和（或）心肌重构的病理生理过程,参与的程度与疾病的早、中期大于晚期。     

Cyclic GMP production by ANP, BNP, and NO during worsening and improvement of chronic heart failure

Cyclic GMP (cGMP) serves as an intracellular second messenger of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and nitric oxide (NO) and its peripheral blood concentration is an index of its biological activity. It has been reported that the plasma concentration of cGMP is correlated with the concentrations of ANP and BNP and is related to the prognosis of chronic heart failure patients, but the relation with NO has not been studied. Therefore, we investigated the roles of ANP, BNP, and NO in relation to cGMP in the blood during worsening and improvement of chronic heart failure. The subjects were 25 patients who were hospitalized in our hospital for acute worsening of chronic heart failure. Plasma concentrations of NO, norepinephrine (NE), ANP, BNP, and cGMP were measured on acute worsening (admission) and improvement (discharge) of heart failure. The cGMP concentration on worsening showed a positive correlation with the NO concentration (r = (0.57, P < 0.01), but no correlations with ANP or BNP were observed. The cGMP concentration on improvement showed no correlation with the NO concentration, but a positive correlation with ANP (r = 0.69, P < 0.001) and BNP (r = 0.67, P < 0.001). No correlation was observed between the NO and NE concentrations. We also studied serious cases of NYHA IV and mild cases of NYHA II to III. The cGMP concentration in the serious group showed a positive correlation with the NO concentration but no correlations with ANP or BNP concentrations on worsening. However, in the mild group, the cGMP concentration during worsening showed positive correlations with both the NO and BNP concentrations. On improvement, the cGMP concentration showed no correlation with the NO concentration but positive correlations with both the ANP and BNP concentrations in both the severe and mild groups. The results suggest the possibility that cGMP is produced mainly by NO during worsening, and by ANP and BNP rather than NO during improvement of chronic heart failure.     

Autoantigen estimation and simple screening assay against cardiodepressant autoantibodies in patients with dilated cardiomyopathy

The objective of this study was to identify the cardiodepressant autoantibodies that could directly influence left ventricular ejection fraction (LVEF) in patients with dilated cardiomyopathy (DCM), as well as to establish a simple screening method for these antibodies. Not only acute hemodynamic but also chronic prognosis improvements were reported with immunoadsorption in some patients with DCM. Various antibodies determined by immunohistochemistry, immunoblotting, and enzyme-linked immunosorbent assay (beta1-adrenergic [beta1-] receptors, muscarinic M2-acetylcholine [M2-] receptors, troponin I, or Na-K-ATPase) were measured in 104 patients with DCM. Cardiodepressant antibodies were also determined by ultrasonic echocardiography (UCG) of 18 day old chick embryos after adding the patients' purified immunoglobulin G, and the following clinical features were compared: age, gender, New York Heart Association class, LVEF, neurohumoral factors, arrhythmias, and other antibodies. We also checked the in vitro immunoadsorption effect against these cardiodepressant antibodies. Cardiodepressant antibodies were found in 63% of 104 patients with DCM and had no relation to other clinical parameters, except for some antibodies such as anti-beta1-receptor antibodies (81% vs. 52%, P < 0.01), anti-M2-receptor antibodies (83% vs. 48%, P < 0.01), or anti-Na-K-ATPase antibodies (85% vs. 55%, P < 0.01). However, cardiodepressant antibodies were similarly found in patients with and without antibodies against troponin I (56% vs. 64%). The LVEF of chick embryos measured by UCG in the presence of patient serum was improved after in vitro immunoadsorption. The ex vivo system using chick embryos was able to determine cardiodepressant antibodies. By multivariate analysis, antibodies against beta1- or M2-receptors was a predictor of these autoantibodies.     

Related factors of dilated cardiomyopathy

Objective To investigate the etiology and relative factors of dilated cardiomyopathy （DCM） in Chinese patients. Methods A case-control study was conducted to compare 233 patients with DCM in high-incidence areas （case group） and 150 patients with stable angina pectoris （control group）. Life styles and history of diseases information was collected by questionaire; human anti-myocardial antibody lgG （AMA- IgG）, human Coxsackie B virus IgG （CBV- IgG） and human adenovirus antibody IgG （ADV- IgG） were measured with ELISA. General chemical and toxicological indicators in drink water from high and low prevalence areas and serum trace elements also were compared. Results 1） Compared with the control group, the case group had more farmers （P 〈 0.01）, with low average incomes （P 〈 0.01 ）, higher alcohol consumption （P 〈 0.01） and higher incidence of the history of myocarditis （P 〈 0.01）. 2） AMA-IgG, CBV-IgG and ADV-IgG levels were low and the positive rates ofAMA-IgG, CBV-IgG and ADV-IgG of patients with DCM were respectively 7.78%, 6.67% and 6.67%, no statistical significance comparing with those in the control group. 3） The content of iron （1.36±2.18 vs 0.39±0.67 rag/L, P〈0.05） and manganese （0.38±0.35 vs 0.15±0.14, P〈0.01） in drinking water of high-incidence areas was significantly higher than that in low-incidence areas. 4） The content of serum iron （69.1±57.8 vs 20.0±17.5 umol/L, P〈0.01 ） and copper （25.7±4.2 vs 19.7±4.5 umol/L, P〈0.01） in the case group evidently exceeded the normal range and obviously higher than that in the control group. Conclusions 1） The incidence of some DCM is related with low incomes, high alcohol consumption and myoearditis. 2） These data do not support that DCM is related with persistent virus infection and autoimmunization; 3） Iron and manganese contents exceeding standards in drinking water and the high content of serum iron and copper is comparatively related with the incidence of DCM.     

扩张型心肌病血清心肌钙蛋白I水平测定的临床意义

目的　探讨扩张型心肌病 (DCM)心力衰竭急性加重时心肌钙蛋白I(cTnI)水平的临床意义。方法　用化学发光免疫分析法测定 42例DCM患者的血清cTnI水平及用超声心动图测量左心室射血分数 (LVEF) ,并与对照组比较。结果　DCM患者血清cTnI水平显著高于对照组 ( 0 .3 11± 0 .3 78vs 0 .0 13± 0 .0 0 9ng/ml,P <0 .0 0 1) ,DCM组中 17例血清cTnI水平升高 ,且cTnI水平与LVEF呈负相关 (P <0 .0 1) ;DCM组中血清cTnI水平高者 6个月死亡率 2 9.4% ,而血清cTnI水平正常者为 4.0 % (P <0 .0 5 )。结论　DCM患者心力衰竭急性加重cTnI水平升高 ,其水平与心力衰竭严重程度呈正相关 ,对判断预后有价值     

扩张型心肌病病因学相关因素分析

目的分析扩张型心肌病（DCM）的病因学相关因素,探讨其与环境、微量元素及病毒感染的关系。方法应用ELISA法检测90例DCM（DCM组）及60例稳定型心绞痛（对照组）患者的血清人心肌抗体-IgC（AMA-IgG）、柯萨奇B组病毒-IgG（CBV-IgG）、腺病毒-IgG（ADV-IgG）,用原子吸收光谱法检测两组血清微量元素。结果DCM组人AMA-IgG、CBV-IgG及ADV-16;阳性率稍高于对照组,但两组比较无统计学差异（P〉0．05）。DCM组血清铁、铜、锰、钙浓度均明显高于对照组（P〈0．01或〈0．05）。结论DCM与持续性病毒感染和自身免疫反应无关;血清铁、铜、锰、钙浓度升高与DCM发病可能有一定关系。     

老年扩张型心肌病与心脏β_1和M_2受体自身抗体的研究

目的　探讨心脏β1和M2 受体的自身抗体在老年扩张型心肌病发生、发展中的临床意义。方法　以细胞外第二环表位肽段的合成肽作为抗原 ,应用酶联免疫吸附测定 (ELISA)技术 ,检测 32例老年扩张型心肌病 (seniledilatedcardiomyopathy,SDCM)、2 6例非老年扩张型心肌病 (non senileDCM ,NSDCM)和 2 0名正常对照的老年人。结果　SDCM组心脏 β1受体自身抗体的阳性率为 2 8.1% (9/32 ) ,NSDCM组为 5 3 .8% (14/2 6 ) ,对照组为 15 .0 % (3/2 0 ,P <0 .0 5 ) ;SDCM组心脏M2 受体自身抗体的阳性率为 31.3% (10 /32 ) ,NSDCM组为 5 7.7% (15 /2 6 ) ,对照组为 2 0 .0 % (4/2 0 ,P<0 .0 1) ;SDCM组心功能Ⅱ～Ⅲ级的两种抗体阳性率及抗体滴度与心功能Ⅳ级比较无明显差异。NSDCM组心功能Ⅱ～Ⅲ级的阳性率及抗体滴度明显高于心功能Ⅳ级。结论　心脏 β1与M2 受体自身抗体的产生与SDCM相关 ,但相关程度低于NSDCM组 ;提示在SDCM患者心功能状态多属晚期的病程中 ,心脏 β1和M2 受体自身抗体的产生 ,可能是病理性免疫机制的参与和生理性老化细胞凋亡的共同作用     

Bovine atrial natriuretic peptide in heart failure

The present study describes the concentration and molecular form of atrial natriuretic peptide (ANP) in Holstein dairy cattle with mild (bacterial endocarditis; BEC) or severe (dilated cardiomyopathy; DCM) heart failure. Significant increases in plasma concentration of ANP were observed in cattle with DCM (73.3 +/- 16.02 pmol/l, n = 4, P less than 0.01) and BEC (20.6 +/- 3.45 pmol/l, n = 7, P less than 0.05), when compared with those in control cattle (14.5 +/- 1.84 pmol/l, n = 12). The concentration of ANP in cattle with DCM was significantly (P less than 0.01) higher compared with that in cattle with BEC. Plasma concentration of ANP correlated significantly with right atrial pressure (r = 0.95, P less than 0.01) and left ventricular end-diastolic pressure (r = 0.84, P less than 0.01). Gel-permeation chromatography of ANP in plasma and the right atrium from control and cattle with BEC revealed a single peak corresponding to the elution position of authentic human ANP(99-126) in plasma, and two peaks corresponding to those of authentic human ANP(99-126) and pro-ANP in the atrial extract. In cattle with DCM, however, peaks corresponding to the elution positions of authentic human beta-ANP and/or pro-ANP were detected in addition to the peak corresponding to ANP(99-126). The content of ANP in the right atrium of cattle with DCM was significantly (P less than 0.05) increased compared with that in control cattle and those with BEC. The present study therefore suggests that the synthesis and secretion of ANP might be stimulated by atrial distention induced by increased atrial pressure.(ABSTRACT TRUNCATED AT 250 WORDS)     

高血压病患者血清抗血管紧张素Ⅱ1型受体自身抗体与心脏重构的相关分析

目的观察抗血管紧张素Ⅱ1型受体（AT1受体）自身抗体对原发性高血压患者心脏重构的影响。方法采用酶联免疫吸附法（ELISA）对592例原发性高血压患者进行血清AT1受体自身抗体检测,并记录患者心脏超声心动图的检查结果。以血清中抗体测定结果将病例分为抗体阳性组和阴性组,运用t检验和）（2检验比较抗体阳性组和抗体阴性组的血压、高血压病病程、血管活性物质和心脏超声结构等的组间差异,运用多元logistic回归分析高血压患者左心室扩大的影响因素。结果592例原发性高血压患者抗AT1受体自身抗体阳性率为38．0％（225／592）。抗AT1受体自身抗体阳性组右心房和左心室内径明显大于抗体阴性组（分别P=0．049,P=0．044,P〈0．05）。多元logistic回归共筛选出4个左心室扩大相关的因素,即血清抗AT1受体自身抗体、男性、高血压病病程和舒张压（P〈0．05）。结论抗AT1受体自身抗体与原发性高血压患者左心室和右心房扩大有关。