扩张型心肌病的病因分析的研究-内科学专业论文.docxVIP

华中科技大学硕士学位论文 华 中 科 技 大 学 硕 士 学 位 论 文 PAGE 10 PAGE 10 [关键词]：扩张型心肌病；病因； 免疫治疗；自身抗体 ABSTRACT Objectives:To analysis the etiology of dilated cardiomyopathy (DCM) and observe the effects of the immunotherapy aimed at the anti-heart antibodies (AHA) on DCM as well as its prognosis. Material and methods:A retrospective study of 301 patients hospitalized for DCM between January 2001 and December 2005 was performed in Union Hospital, Wuhan , China. The evaluation included medical history and results of the follow-up. Results: Vir as could be detected in 185 of 301 patients (61.46%) , meanwhile the anti-myocardial antibody could be found in 207 patients (68.77%) . The virashad marked correlation to AHA. There were 46 of 301 patients( 15.28 %) who had the autoantibodies against ANT were treated with dilthiazem 90mg daily and standard conventional therapy (group A) , there were 29 of 301( 9.63 %) patients who had the autoantibodies against ? 1 - adrenoceptor were treated with metoprolol and standard conventional therapy (group B),the patients with the autoantibodies against ANT and against ? 1 - adrenoceptor were group C, after the median follow-up of 2.1±1.6 years , t he patients gained one to two NYHA class, their ratio of coeur and thorax ( HTR ), left ventricular end diastolic dimension(LVEDd) and left ventricular ejection fraction(LVEF) were significantly improved compared with prior treatment . Conclusion:Viral infection/autoimmunity was the common causes of DCM. The early immunotherapy with dilthiazem and metoprolol aimed directly at autoantibody against ANT and β1-adrenoceptor could obviously improve the cardiac function and quality of life of the patients with DCM. [Keywords] Dilated cardiomyopathy , Etiology, Immunotherapy, Autoantibody 1 绪言 扩张型心肌病(DCM)是导致心力衰竭的主要原因之一，其病因和发病机制尚未完 全阐明。近年来随着免疫学 、病毒学和分子生物学理论与技术发展，DCM 免疫学和 临床治疗的研究逐步深入, 研究者发现病毒持续感染 、免疫异常应答与 DCM 的发病 密切相关 ［1］ ，提出地尔硫卓能够对抗 DCM 自身免疫性损伤。鉴此,我们运用临床回 顾性研究进一步分析病毒/自身免疫在 DCM 患者发病中的作用，