Specific Immunoadsorption Therapy Using a Tryptophan Column in Patients with Refractory Heart Failure Due to Dilated Cardiomyopathy
Specific Immunoadsorption Therapy Using a Tryptophan Column in Patients with Refractory Heart Failure Due to Dilated Cardiomyopathy
复制标题
DOI：
10.1002/jca.20268
复制
发表时间：
2011-01-01
影响因子：
1.5
通讯作者：
Yoshikawa, Tsutomu
中科院分区：
文献类型：
--
作者：
Nagatomo, Yuji;Baba, Akiyasu;Yoshikawa, Tsutomu
背景资料：在扩张型心肌病（DCM）患者中发现的某些心脏特异性自身抗体在介导心肌损伤和致命性室性心律失常中发挥作用，导致心脏性猝死。免疫吸附疗法（IA）是去除此类自身抗体的治疗工具之一。来自德国的临床研究表明，使用负载羊抗人IgG或蛋白A的柱的非特异性IA改善了血液动力学数据，并对DCM所致心力衰竭（HF）患者的心功能和存活率产生了有利影响。本研究的目的是确定使用对IgG 3亚类具有高亲和力的高轮廓色氨酸柱的IA治疗是否对常规治疗难治的重度HF患者的心功能产生有利影响。方法和结果：16例DCM患者（年龄53 ± 4岁，男性8例，纽约心脏协会功能分级III/IV级，平均射血分数18 ± 2%）接受了IA治疗。研究受试者具有针对β 1-肾上腺素能或M2-毒蕈碱受体的自身抗体。IA后血浆脑钠肽水平显著降低（P = 0.016）。血浆炎症细胞因子包括白细胞介素-6和肿瘤坏死因子-a在每次IA后均无变化。IA后6分钟步行距离显著增加（P = 0.01）。左室射血分数在IA后3个月增加了3%（P = 0.039）。结论：我们的初步经验证明了使用新的IgG 3特异性色氨酸柱对DCM所致晚期HF患者进行IA的安全性和短期疗效。需要长期随访以确认对此类患者心功能和发病率/死亡率的影响。J. Clin. Apheresis 26：1-8，2011. (C)2010 Wiley-Liss，Inc.
Background: Certain cardiac-specific autoantibodies found in patients with dilated cardiomyopathy (DCM) play a role in mediating myocardial damage and fatal ventricular arrhythmias resulting in sudden cardiac death. Immunoadsorption therapy (IA) is one of the therapeutic tools to remove such autoantibodies. Clinical studies from Germany have shown that nonspecific IA using columns loaded by sheep antihuman IgG or protein A improved hemodynamic data and affected favorably cardiac function and survival in patients with heart failure (HF) due to DCM. The goal of this study is to determine if IA therapy using the high-profile tryptophan column, which has high affinity for IgG3 subclass, affects favorably cardiac function in patients with severe HF who are refractory to conventional therapy. Methods and Results: IA therapy was conducted in 16 patients with DCM (age 53 +/- 4, male 8, New York Heart Association functional class III/IV, mean ejection fraction 18 +/- 2%). Study subjects had autoantibodies directed against either beta 1-adrenergic or M2-muscarinic receptors. Plasma brain natriuretic peptide levels were significantly decreased after IA (P = 0.016). Plasma inflammatory cytokines including interleukin-6 and tumor necrosis factor-a did not change after each session of IA. Six-minute walk distance was significantly increased after IA (P = 0.01). Left ventricular ejection fraction increased by 3% 3 months after IA (P = 0.039). Conclusions: Our initial experience demonstrated safety and short-term efficacy of IA using a new IgG3-specific tryptophan column for patients with advanced HF due to DCM. Long-term follow-up is needed to confirm the effects on cardiac function and morbidity/mortality in such patients. J. Clin. Apheresis 26:1-8, 2011. (C) 2010 Wiley-Liss, Inc.