CAJ | 학술논문

目的观察大量丙种球蛋白治疗扩张型心肌病心力衰竭患者心肌肌凝蛋白重链（CM HC ）自身IgG抗体滴度的变化及疗效。方法将28例扩张型心肌病心力衰竭患者作为实验组，其中14例在传统治疗基础上加用大剂量丙种球蛋白作为治疗组，其余14例为标准对照组，同时设健康体检者28例为健康对照组，用酶联免疫吸附试验（ELISA）法检测CMHC自身IgG抗体。结果未用丙种球蛋白治疗前扩张型心肌病心力衰竭组CM HC自身IgG抗体与健康对照组比较差异有统计学意义（ P＜0．05）；治疗12周后实验组好转11例（78．57％），标准对照组好转5例（35．71％），且治疗组与健康对照组CM HC自身IgG抗体比较未见明显差异。治疗组左室射血分数由（36．12±9．98）％提高至（46．15±12．18）％，左室舒张末内径由（59．68±9．60）mm缩小至（50．05±10．20）m m ，治疗后较标准对照组疗效显著。结论大量丙种球蛋白治疗扩张型心肌病心力衰竭与传统方法比较疗效明显，且降低了体内CM HC自身IgG抗体滴度。
목적관찰대량병충구단백치료확장형심기병심력쇠갈환자심기기응단백중련（CM HC ）자신IgG항체적도적변화급료효。방법장28례확장형심기병심력쇠갈환자작위실험조，기중14례재전통치료기출상가용대제량병충구단백작위치료조，기여14례위표준대조조，동시설건강체검자28례위건강대조조，용매련면역흡부시험（ELISA）법검측CMHC자신IgG항체。결과미용병충구단백치료전확장형심기병심력쇠갈조CM HC자신IgG항체여건강대조조비교차이유통계학의의（ P＜0．05）；치료12주후실험조호전11례（78．57％），표준대조조호전5례（35．71％），차치료조여건강대조조CM HC자신IgG항체비교미견명현차이。치료조좌실사혈분수유（36．12±9．98）％제고지（46．15±12．18）％，좌실서장말내경유（59．68±9．60）mm축소지（50．05±10．20）m m ，치료후교표준대조조료효현저。결론대량병충구단백치료확장형심기병심력쇠갈여전통방법비교료효명현，차강저료체내CM HC자신IgG항체적도。
Objective To observe the anti-cardiac myosin heavy chain IgG changes and efficacy of the antibody titration during the treatment of dilated cardiomyopathy (DCM ) complicating heart failure by a large number of gamma globulin .Methods 28 inpa-tients with dilated cardiomyopathy complicating heart failure were taken as the experimental group ,28 cases of healthy examination as the control group .The anti-cardiac myosin heavy chain IgG antibodies were detected by ELISA ;moreover ,among the patients with heart failure treated by the conventional therapy ,14 cases were selected and added large dose of gamma globulin for observing the curative effect .The remaining 14 cases were taken as the standard control group of this experiment .The anti-cardiac myosin heavy chain IgG antibodies were detected by ELISA .Results The anti-cardiac myosin heavy chain IgG antibodies before gamma globulin therapy in the DCM complicating heart failure group had statistical difference compared with the healthy examination goup (P<0 .05);in the 14 cases of heart failure treated by large dose of gamma globulin ,11 cases (78 .57% ) in the treatment group were improved ,while 5 cases(35 .71% ) in the standard control group were improved ,the anti-cardiac myosin heavy chain IgG antibody had no significant differences between the gamma globulin treatment group and the healthy examination group .The left ventricular ejection fraction(LVEF) in the gamma globulin treatment group was increased from (36 .12 ± 9 .98)% to (46 .15 ± 12 .18)% ,the left ventricular end-diastolic diameter was decreased from (59 .68 ± 9 .60) mm to (50 .05 ± 10 .20) mm ,the effects after gamma glob-ulin treatment were more significant than the conventional traditional control group .Conclusion Large dose of gamma globulin for treating dilated cardiomyopathy complicating heart failure has more significant effect than the traditional method ,reduces the titra-tion of in vivo anti-cardiac myosin heavy chain IgG antibody and contributes to explain the drug action mechanism from immune mechanism .