摘要目的本研究拟对不同心脏病所致的心力衰竭(CHF)患者,检测心脏β1和M2受体的自身抗体,探讨心功能发生病理变化时,这两种自身抗体的产生与疾病发生、发展的相关性.方法以细胞外第二环表位肽段的合成肽作为抗原,应用酶联免疫吸附测定(ELISA)技术,随机检测265例受试者血清中心脏β1和M2受体的自身抗体.188例为不同心脏病CHF患者,其中缺血性心肌病(ICD)42例、扩张型心肌病(IDCM)52例、高血压性心脏病(HHD)44例、风湿性心脏病50例;单纯高血压(HP)36例及正常人(NC)41例为对照组.结果 CHF组β1 受体自身抗体的阳性率为45.7% (86/188),明显高于HP组和NC组的10.4% (8/77) (P<0.01);CHF组M2受体自身抗体的阳性率为49.5% (93/188),明显高于HP组和NC组的11.7% (9/77) (P<0.01);心功能Ⅱ-Ⅲ级的阳性率及抗体滴度明显高于Ⅳ级;CHF组β1受体自身抗体阳性血清中高达56.1%的患者同时具有M2受体的自身抗体.结论心脏β1 和M2受体自身抗体存在于多种心脏病心力衰竭患者的血清中,可能与心力衰竭时心肌结构变化和功能下降有关,与原发心脏病无明显因果关系;β1和M2受体的双抗体阳性可能是自身免疫反应的多重性表现,提示免疫学机制参与心力衰竭和/或心肌重构的病理生理过程,参与的程度在疾病的早、中期大于晚期.

abstractsObjective To determine whether autoantibodies against β1-adrenergic and M2-muscarinic receptors are related to patients with congestive heart failure (CHF).Methods Both synthetic peptides corresponding to amino acids sequence 197-222 and 169-173 of the second extracellular loops of the β1 and M2 receptors were used as antigens to screen sera from 265 patients. 188 were congestive heart failure (CHF) patients with different heart diseases, among them 42 were ischemic cardiomyopathy (ICD) and 52 were idiopathic dilated cardiomyopathy (IDCM),44 were hypertensive heart disease (HHD),50 were rheumatic valvular heart disease (RVHD); 77 were controls, among them 36 were simple hypertension and 41 were healthy donors (NC).Results Positive sera for β1-adrenergic receptor was found in 45.73% (86/188) of CHF patients, while in the controls it was 10.4% (8/77) (P<0.01); positive sera for M2-muscarinic receptor in CHF patients was found in 49.5% (99/188), while in the control it was 11.7% (9/77) (P<0.01). The positive ratio of autoantibodies against β1-adrenergic and M2-muscarinic receptors in CHF patients with cardiac function class Ⅱ-Ⅲ (NYHA) were significantly higher than cardiac function class Ⅳ. The average titer of autoantibodies against β1-adrenergic and M2-muscarinic receptors of the former was significantly higher than the latter; 56.1% of patients with autoantibodies against β1-adrenergic receptor had autoantibodies against M2-muscarinic receptor.Conclusions Autoantibodies against β1-adrenergic receptor and M2-muscarinic receptor were found in sera from heart failure patients with different cardiac diseases. We propose that autoantibodies against β1 and M2 receptors are not only related to the IDCM, but also to cardiac structural and functional changes.