血清肌鈣蛋白I升高與病毒性心肌炎診斷及病程關(guān)系探討(3)
原發(fā)性擴(kuò)張型心肌病患者血清中出現(xiàn)抗β腎上腺素能受體、抗膽堿能M受體抗體等,自身抗體發(fā)揮受體激動(dòng)劑效應(yīng),參與了發(fā)病和進(jìn)展[10]。本研究對(duì)cTnI持續(xù)升高的VMC患者25例以及病毒擴(kuò)增陽(yáng)性、cTnI升高的15例進(jìn)行觀察,血清內(nèi)出現(xiàn)抗M受體抗體,減少心肌M2數(shù)目,降低親和力,即導(dǎo)致M受體下調(diào)和去敏(表1)。cTnI持續(xù)升高、CVB陽(yáng)性的VMC血清與擴(kuò)張型心肌病患者血清內(nèi)抗M受體抗體對(duì)心肌M2受體下調(diào)和去敏作用相似。由此不難看出,cTnI持續(xù)升高的患者,至少其中一部分自身免疫紊亂、損傷心肌M受體,可能已開始VMC向擴(kuò)張型心肌病的進(jìn)程。mtDNA轉(zhuǎn)錄和編譯氧化磷酸化酶調(diào)節(jié)細(xì)胞內(nèi)的能量產(chǎn)生和利用,mtDNA特別易受損傷而發(fā)生缺失和變異。本研究提示,VMC淋巴細(xì)胞mtDNA缺失發(fā)生率是對(duì)照組的15.8倍,VMC患者心肌細(xì)胞mtDNA缺失發(fā)生率比正常人高2.5倍 (表2)。cTnI持續(xù)升高的VMC患者mtDNA改變與向擴(kuò)張型心肌病發(fā)展的關(guān)系尚待進(jìn)一步探討。
本研究受國(guó)家"九.五"課題(衛(wèi)科教計(jì)發(fā)1996第85號(hào))及江蘇省科委社會(huì)發(fā)展基金(DS97028與DS98039)資助
參考文獻(xiàn)
1 全國(guó)心肌炎、心肌病專題研討會(huì)組委會(huì).全國(guó)心肌炎、心肌病專題研討會(huì)紀(jì)要.臨床心血管病雜志,1995 ,11:324-362 .
2 張寄南,楊國(guó)平,蘇恩本,等.血清肌鈣蛋白I診斷急性心肌梗塞的研究.中華心血管病雜志,1997,25:379-382.
3 賈永平,楊志健,張寄南,等.經(jīng)皮冠狀動(dòng)脈腔內(nèi)成形術(shù)前后血清肌鈣蛋白I的變化.中國(guó)循環(huán)雜志,1999, 14:75-77.
4 Smith SC, Ladenson JH, Mason JW, et al. Elevation of cardiac troponin I associated with myocarditis: experimental and clinical correlates.Circulation, 1997,95:163-168.
5 Lauer B, Niederau C, Kuhl V, et al. Cardiac troponin T in patients with clinically suspected myocarditis. J Am Coll Cardiol, 1997,30:1354-1359.
6 Kim M, Kim K. Changes in cardiac troponin I in Kawasaki disease before and after treatment with introvenous gammaglobin. Jpn Circulation ,1998 ,62:479-482 .
7 Apple FS. Clinical and analytical standardization issues confronting cardiac troponin I. Clin Chem, 1999,45:18-20.
8 Bordor GS, Pot Porter S,Ladenson JH, et al. Development of monoclo-nal antibodies for an assay of cardiac troponin I and preliminary results in susfected cases of myocardial infarction. Clin Chem, 1992,38:2203-2214.
9 蘇恩本,張寄南,徐晉丹,等.單抗法測(cè)定肌酸激酶與肌鈣蛋白I診斷急性心肌梗塞的比較性研究.中華內(nèi)科雜志,1998,37:25.
10 Matsui S, Fu M . Characteristic distribution of circulation autoantibodies against G-protein coupled cardiovascular receptor in patientes with idiopathic dilated and hypertropnic cardiomyopathy. International Jaurnal of Cardiology,1996,54:143-147., http://www.www.srpcoatings.com(張寄南 蘇恩本 魏瑾 趙美華 劉治全 榮燁之 馬文珠)
本研究受國(guó)家"九.五"課題(衛(wèi)科教計(jì)發(fā)1996第85號(hào))及江蘇省科委社會(huì)發(fā)展基金(DS97028與DS98039)資助
參考文獻(xiàn)
1 全國(guó)心肌炎、心肌病專題研討會(huì)組委會(huì).全國(guó)心肌炎、心肌病專題研討會(huì)紀(jì)要.臨床心血管病雜志,1995 ,11:324-362 .
2 張寄南,楊國(guó)平,蘇恩本,等.血清肌鈣蛋白I診斷急性心肌梗塞的研究.中華心血管病雜志,1997,25:379-382.
3 賈永平,楊志健,張寄南,等.經(jīng)皮冠狀動(dòng)脈腔內(nèi)成形術(shù)前后血清肌鈣蛋白I的變化.中國(guó)循環(huán)雜志,1999, 14:75-77.
4 Smith SC, Ladenson JH, Mason JW, et al. Elevation of cardiac troponin I associated with myocarditis: experimental and clinical correlates.Circulation, 1997,95:163-168.
5 Lauer B, Niederau C, Kuhl V, et al. Cardiac troponin T in patients with clinically suspected myocarditis. J Am Coll Cardiol, 1997,30:1354-1359.
6 Kim M, Kim K. Changes in cardiac troponin I in Kawasaki disease before and after treatment with introvenous gammaglobin. Jpn Circulation ,1998 ,62:479-482 .
7 Apple FS. Clinical and analytical standardization issues confronting cardiac troponin I. Clin Chem, 1999,45:18-20.
8 Bordor GS, Pot Porter S,Ladenson JH, et al. Development of monoclo-nal antibodies for an assay of cardiac troponin I and preliminary results in susfected cases of myocardial infarction. Clin Chem, 1992,38:2203-2214.
9 蘇恩本,張寄南,徐晉丹,等.單抗法測(cè)定肌酸激酶與肌鈣蛋白I診斷急性心肌梗塞的比較性研究.中華內(nèi)科雜志,1998,37:25.
10 Matsui S, Fu M . Characteristic distribution of circulation autoantibodies against G-protein coupled cardiovascular receptor in patientes with idiopathic dilated and hypertropnic cardiomyopathy. International Jaurnal of Cardiology,1996,54:143-147., http://www.www.srpcoatings.com(張寄南 蘇恩本 魏瑾 趙美華 劉治全 榮燁之 馬文珠)
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