钙通道自身抗体预测慢性心力衰竭患者死亡风险的研究  

Calcium Channel Autoantibodies Predict the Risk of Death in Patients with Chronic Heart Failure

作　　者：于海云[1] 裴娟慧[1] 刘霄燕[1] 浦介麟[1] 

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外心血管病医院心血管疾病国家重点实验室,北京100037

出　　处：《中国分子心脏病学杂志》2014年第2期864-868,共5页Molecular Cardiology of China

基　　金：973项目(编号:2013CB531105)

摘　　要：目的目前的研究发现钙通道自身抗体(CC-AAbs)参与了扩张型心肌病(DCM)的发病并起到重要作用,其在缺血性心肌病(ICM)所致慢性心力衰竭(CHF)中是否具有作用尚不清楚,本研究旨在评价CC-AAbs在ICM导致的CHF患者中的表达水平及作用。方法共入选1255例CHF组患者及834例对照组受试者,酶联免疫法检测CC-AAbs的表达水平,应用Kaplan-Meier曲线及Cox回归检验进行组间比较,并分析CC-AAbs表达与ICM病人预后的相关性,确定CC-AAbs是否为ICM患者猝死(SCD)、非猝死性死亡(NSCD)和全因死亡的独立预测因子。结果完成随访1099例,失访156例(失访率12.4%),发生死亡330例,猝死121例,随访中位数为52月(0.40-92月)。CHF患者中CC-AAbs的阳性表达明显高于正常对照(4.64%vs.1.20%,p<0.001)。Cox回归分析表明阳性CC-AAbs与CHF患者的死亡呈明显正相关,CC-AAbs阳性可以预测ICM患者的猝死(HR:2.805,95%CI:1.488-5.288)、非猝死性死亡(HR:1.887,95%CI:1.081-3.293)及全因死亡(HR:2.219,95%CI:1.461-3.371)。结论我们的研究表明:ICM导致的CHF患者中CC-AAbs的水平明显增加,并且CC-AAbs的表达与CHF患者的SCD、NSCD及全因死亡具有明显相关性,是CHF患者SCD、NSCD和全因死亡的独立预测因子。Objective Recent studies indicated that calcium channel autoantibodies （CC-AAbs） have been detected in patients with dilated cardiomyopathy （DCM） and may play an important role in autoimmune pathogenesis. It is still unclear the effect of CC-AAbs in patients with chronic heart failure （CHF） from ischemic cardiomyopathy （ICM）. The purpose of this study was to evaluate whether CC-AAbs levels could predict prognosis in CHF patients. Method A total of 1255 ICM patients and 834 control subjects were recruited. CC-AAbs were detected by enzyme-linked immunosorbent assay （ELISA） and the relationship between CC-AAbs and patient prognosis were analyzed. Result During a median follow-up time of 52 months （0.40-92 months）, there were 330 deaths. Of these, sudden cardiac death （SCD） occurred in 121 cases. The presence of CC-AAbs in ICM patients were significantly higher than that of the controls （4.64% vs. 1.20%, both p〈0.001）. Multivariate analysis revealed that positive CC- AAbs was associated with higher mortality in ICM patients and that it predicted SCD （HR 2.805, 95% CI 1.488-5.288） and all-cause death （HR 2.219, 95% CI 1.461-3.371 for ICM）. A significant association between CC-AAbs and non-SCD （NSCD） was also found in ICM patients （HR=1.887, 95% CI 1.081-3.293）. Conclusion Our results demonstrated that presence of CC-AAbs was higher in ICM patients versus controls and corresponds to a higher incidence of all-cause death and SCD. Positive CC-AAbs may serve as an independent predictor for SCD and all-cause death in these patients.

关 键 词：钙通道自身抗体 猝死 缺血性心肌病 

分 类 号：R541.6[医药卫生—心血管疾病]