免疫吸附疗法应用于扩张型心肌病患者的1例病例报告并荟萃分析  

A case report and meta-analysis for immunoadsorption therapy in patients with dilated cardiomyopathy

作　　者：何芳 唐婷婷 谢天 袁璟[1] 廖梦阳 王敏[1] 廖玉华[1] 程翔[1] HE Fang;TANG Tingting;XIE Tian;YUAN Jing;LIAO Mengyang;WANG Min;LIAO Yuhua;CHENG Xiang(Department of Cardiology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院心内科,武汉430022

出　　处：《临床心血管病杂志》2022年第3期233-240,共8页Journal of Clinical Cardiology

摘　　要：目的:探讨免疫吸附疗法应用于扩张型心肌病(DCM)患者的有效性和安全性。方法:本研究在国内首次报道免疫吸附疗法成功应用于1例DCM患者,并通过荟萃分析系统性评价免疫吸附疗法在DCM患者中的有效性与安全性。荟萃分析中,我们检索PubMed、Embase、Web of Science-MEDLINE、Cochrane Library、CENTRAL和ClinicalTrials.gov等数据库,查找2000年1月1日—2021年11月26日以英文发表的免疫吸附疗法治疗DCM的临床研究。应用Stata MP Version 15.0和GraphPad Prism Version 7.0软件进行荟萃分析和统计分析。结果:该例DCM患者接受单疗程的免疫吸附治疗后,在18个月随访期间,N末端脑钠肽原下降,左室射血分数增加以及左室舒张末期内径减低。荟萃分析最终纳入11篇文献,包括313例DCM患者,其中免疫吸附组167例,对照组146例,平均随访时间为3~30个月。与对照组相比,免疫吸附组DCM患者NYHA心功能分级得到明显改善(P<0.0001),伴左室射血分数升高(WMD=6.70,95%CI:5.28~8.12)和左室舒张末期内径减低(WMD=-3.65,95%CI:-4.12~-3.19)。免疫吸附组患者未见感染、大出血、肾功能恶化等严重并发症的报道。结论:免疫吸附疗法可明显改善DCM患者的心功能和逆转心脏重构。Objective:The purpose of this study was to evaluate the efficacy and safety of immunoadsorption(IA)therapy for patients with dilated cardiomyopathy(DCM).Methods:For the first in China,we successfully treated one DCM patient with IA therapy.We performed a meta-analysis to systematically evaluate the efficacy and safety of IA therapy in patients with DCM.We searched databases including PubMed,Embase,Web of Science-MEDLINE,Cochrane Library,CENTRAL and ClinicalTrials.gov for clinical trials of IA therapy in DCM patients,which published in English from January 1st,2000to November 26th,2021.Data were analyzed using Stata MP 15.0and GraphPad Prism 7.0.Results:After receiving one course of IA therapy,the DCM patient showed decreased N-terminal pro-B-type natriuretic peptide and left ventricular end-diastolic diameter(LVEDD),and increased left ventricular ejection fraction(LVEF)during the 18months of follow-up.11trials with a total of 313DCM patients were included in the meta-analysis(n=167in the IA group and n=146in the control group).The mean follow-up time ranged from 3to 30months.Compared with the control group,DCM patients of the IA group showed improvements in the NYHA functional classification(P<0.0001),LVEF(WMD=6.70,95%CI:5.28~8.12)and LVEDD(WMD=-3.65,95%CI:-4.12~-3.19).In the IA group,no major complications such as infection,major bleeding or worsening of renal function were reported.Conclusion:IA therapy significantly improve cardiac function and reverse cardiac remodeling in DCM patients.

关 键 词：免疫吸附 扩张型心肌病 病例报告 荟萃分析 

分 类 号：R542.2[医药卫生—心血管疾病]