Immunoglobulin adsorption in patients with idiopathic dilated cardiomyopathy
Immunoglobulin adsorption in patients with idiopathic dilated cardiomyopathy
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DOI：
10.1161/01.cir.101.4.385
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发表时间：
2000-02-01
期刊：
影响因子：
37.8
通讯作者：
Hetzer, R
中科院分区：
文献类型：
--
作者：
Müller, J;Wallukat, G;Hetzer, R
背景-特发性扩张型心肌病（IDC）通常是一种进行性疾病，无病因治疗选择。以下假设，在某些患者的自身抗体对心脏结构可能会诱导，维持，或促进疾病的进展，我们调查是否消除这些自身抗体通过免疫吸附将改善心脏function.Methods和Results-This前瞻性病例对照研究包括34例IDC。每例患者均表现为中度至重度心力衰竭，并有针对β（1）-肾上腺素受体（β（1）-AAB）的自身抗体的证据。17例患者接受标准药物治疗（对照组），而17例患者也接受免疫吸附治疗（治疗组）以消除β（1）-AAB。1年随访包括超声心动图评估左心室射血分数和内径、β（1）-AAB水平和临床状态，每3个月一次。1年内，平均+/- SD左心室射血分数从22.3 +/- 3.3%上升至37.9 +/- 7.9%（P = 0.0001），治疗组相对增加69.9%，而对照组总体无增加（从23.8 ± 3.0%至25.2 ± 5.9%，P = 0.3154）。治疗组的左心室直径从74.5 +/- 7.1 mm减小14.5%至63.7 +/- 6.0 mm（P = 0.0001），对照组减小3.8%（P = 0.2342）。在治疗组中，免疫吸附后NYHA心功能评分改善（P = 0.0001）。β（1）-AABs没有再增加。结论：在IDC中，使用免疫吸附上级使用标准药物治疗。它显著改善心脏性能和临床状态。
Background-Idiopathic dilated cardiomyopathy (IDC) frequently is a progressive disease without causative therapy options. Following the hypothesis that in certain patients autoantibodies against cardiac structures may induce, maintain, or promote the progression of the disease, we investigated whether the elimination of these autoantibodies through immunoadsorption would improve cardiac function.Methods and Results-This prospective case-control study included 34 patients with IDC. Each patient presented with moderate to severe heart failure and evidence of autoantibodies directed against beta(1)-adrenoceptors (beta(1)-AABs), Seventeen patients received standard medical therapy (control group), whereas 17 were also treated with immunoadsorption (treatment group) to eliminate beta(1)-AABs. A 1-year follow-up included echocardiographic assessment of left ventricular ejection fraction and internal diameters, beta(1)-AAB levels, and clinical status every 3 months. Within 1 year, the mean +/- SD left ventricular ejection fraction rose from 22.3 +/- 3.3% to 37.9 +/- 7.9% (P = 0.0001) in the treatment group, with a relative increase of 69.9%, However, in the control group, no overall increase was seen (from 23.8 +/- 3.0% to 25.2 +/- 5.9%, P = 0.3154). Left ventricular diameter in diastole decreased by 14.5% from 74.5 +/- 7.1 to 63.7 +/- 6.0 mm in the treatment group (P = 0.0001) and by 3.8% (P = 0.2342) in the control group. In the treatment group, the NYHA functional rating improved after immunoadsorption (P = 0.0001). beta(1)-AABs did not increase anew.Conclusions-In IDC, the use of immunoadsorption is superior to the use of standard medical therapy. It significantly improves cardiac performance and clinical status.