扩张型心肌病患者血清自身抗体、心钠素、一氧化氮含量的变化及意义

目的　探讨扩张型心肌病 (DCM)患者血清抗 β1 肾上腺能受体与 M2 胆碱能受体自身抗体水平、心钠素(ANP)和一氧化氮 (NO)含量的变化及意义。方法　用 EL ISA法检测 62例 DCM患者和 76例健康人血清抗β1 肾上腺能受体与 M2 胆碱能受体自身抗体 ;用放射免疫法和硝酸还原酶法测定 40例 DCM患者和 19例健康人血清ANP、NO水平。结果　 (1) DCM患者血清自身抗体的 P/ N值和阳性率明显高于正常对照组 (P<0 .0 5或 0 .0 1) ;(2 ) DCM患者血清 ANP、NO水平亦高于正常对照组 (P<0 .0 5 ) ;(3 )抗β1 抗体阳性组血清 ANP、NO水平高于阴性组 (P<0 .0 5或 0 .0 1) ;(4)抗 M2 抗体阳性组血清 ANP水平高于阴性组 (P<0 .0 1) ,而 NO水平无显著差异 (P>0 .0 5 )。结论　 (1) DCM患者血清中存在高水平的抗β1 和 M2 受体自身抗体、ANP和 NO;(2 )自身抗体有致心肌细胞肥大的作用 ,可能参与 DCM心室重构 ;(3 )抗 β1 和 M2 受体的自身抗体在心室重构中存在不同的信号通路

Changes of serum autoantibodies, atrial natriuretic peptide and nitric oxide in patients with dilated cardiomyopathy and its clinical significance

Objective To investigate the levels of autoantibodies against β 1 adrenergic and M 2 muscarinic receptors, atrial natriuretic peptide(ANP) and nitric oxide(NO) in patients with dilated cardiomyopathy(DCM), and to evaluate the relationship between autoantibodies and ANP, NO. Methods A assay called ELISA was used to detect the levels of serum anti β 1 and M 2 receptor antibodies in 62 patients with DCM and 76 healthy subjects. The concentrations of serum ANP and NO were determined using radioimmunoassay or nitrate reduction method in 40 DCM patients and 19 healthy subjects. Results The values of P/N and positive frequencies of autoantibodies in DCM group were greatly higher than those in control group( P <0.05 or 0.01), similar results were also seen in serum concentration of ANP and NO( P <0.05).There were significant difference of serum ANP( P <0.05) and NO ( P <0.01)between positive and negative anti β 1 antibody groups. Serum concentration of ANP in positive anti M 2 antibody group was significantly higher than that in negative anti M 2 antibody group( P <0.01), and there was no difference in the level of NO in the two groups ( P >0.05). Conclusion There were higher levels of serum autoantibodies,ANP, and NO in DCM patients compared with normal control. The autoantibodies may have pathophysiologic importance to ventricular remodeling in DCM by their hypertrophic effects on myocytes .The serum concentration of NO was correlated with anti β 1 antibody but not with anti M 2 antibody, which indicated different signal transduction pathway between anti β 1 and M 2 antibodies in ventricular remodeling of DCM.