扩张型心肌病的病因及免疫治疗进展  

Progress of etiology and immunotherapy of dilated cardiomyopathy

作　　者：沈启明 王慧 张建忠[1] 马丽红[2] 张义红 SHEN Qiming;WANG Hui;ZHANG Jianzhong;MA Lihong;ZHANG Yihong(Department of Cardiology,Linyi Hospital of Traditional Chinese Medicine,Shandong Province,Linyi 276000,China;Department of Traditional Chinese Medicine,Fuwai Hospital,Beijing 100032,China;Department of Intensive Care Medicine,Linyi People's Hospital,Shandong Province,Linyi 276000,China)

机构地区：[1]山东省临沂市中医医院心内科,山东临沂276000 [2]北京阜外医院中医科,北京100032 [3]山东省临沂市人民医院重症医学科,山东临沂276000

出　　处：《中国当代医药》2024年第13期161-164,共4页China Modern Medicine

基　　金：科学技术部科技创新2030——“新一代人工智能”重大项目(2021ZD0111003)。

摘　　要：扩张型心肌病(DCM)是一种严重危害人类健康的疾病,以左室收缩功能障碍和左室增大为特征,发病率较高,预后较差。DCM的发病机制是多因素致病,包括遗传因素和后天因素,遗传因素主要是指基因突变,Titin(TTN)基因突变和Lamin AC(LMNA)基因突变是DCM遗传病因中最常见的突变类型。后天因素包括感染、酒精和免疫介导。现有研究表明,病毒感染和免疫反应引起心肌损伤和产生抗自身心肌抗体,在DCM的发生、发展过程中发挥着重要作用。针对相关病因的特异性治疗逐渐成为研究热点之一。在常规的利尿、扩血管、延缓心室重构等治疗方法基础上,通过免疫疗法去除抗心肌抗体阳性患者的抗心肌抗体,可减少扩张型心肌病患者心肌炎症,改善心功能及预后。但目前免疫疗法尚缺乏大规模临床试验的证据支持,仅是DCM患者的一种实验性治疗选择。Dilated cardiomyopathy(DCM)is a disease that seriously endangers human health.It is characterized by left ventricular systolic dysfunction and left ventricular enlargement,with a high incidence rate and poor prognosis.The pathogenesis of DCM is multifactorial,including genetic and acquired factors.Genetic factors mainly refer to gene mutations,with Titin(TTN)gene mutations and Lamin AC(LMNA)gene mutations being the most common types of mutations in the genetic etiology of DCM.Acquired factors include infection,alcohol,and immune mediation.Existing research has shown that viral infection and immune response cause myocardial damage and produce anti automyocardial antibodies,which play an important role in the occurrence and development of DCM.Specific treatment for related causes has gradually become one of the research hotspots.On the basis of conventional treatment methods such as diuresis,vasodilation,and delayed ventricular remodeling,immunotherapy can be used to remove anti myocardial antibodies from patients with positive anti myocardial antibodies,which can reduce myocarditis in patients with dilated cardiomyopathy,improve heart function,and prognosis.However,currently immunotherapy lacks evidence from large-scale clinical trials to support it,and is only an experimental treatment option for DCM patients.

关 键 词：扩张型心肌病 病因 免疫疗法 进展 

分 类 号：R542.2[医药卫生—心血管疾病]