Mitelman J, Gimenez L, Aparicio N J, Cortelezzi M
Department of Cardiology, Teodoro Alvarez Hospital, Buenos Aires, Argentina.
J Cardiol. 1999 Oct;34(4):189-97.
Chagas disease involves a cardiac impairment, being the first alterations of autonomic disorders which affect heart rate and blood pressure control. At this stage, diminished heart rate responses to atropine and propranolol are observed. Prior studies have shown that short term ganglioside treatment improves the responses to these agents, but there is no information about the long term effect of gangliosides and the evolution of antiGM1 titers. The effects of long term treatment with gangliosides on autonomic tests in patients with chagasic cardiodisautonomy and the evolution of antiGM1 titers were studied in 90 patients (57 men, 33 women, aged 25-60 years) with positive serology for Chagas disease and electrocardiogram showing sinusal bradycardia and incomplete right branch block, without cardiomegaly, with autonomic alterations by postural and Valsalva's tests. All patients were submitted to a test that consisted of intravenous injection of atropine 0.04 mg/kg followed 3 min later by intravenous injection of propranolol 0.2 mg/kg. During these tests heart rate and blood pressure were recorded continuously. Subsequently, 30 patients were treated with 100 mg/day of a mixture of gangliosides by intramuscular injection during 15 days in a row, followed by 40 mg/day during another 75 days. Another 30 patients received continuous treatment for 12 months. The remaining 30 patients were controls. The antiGM1 antibody circulating titers were determined before the treatment, at the third and 12th month. Seventy-four patients completed the study. Before treatment, the heart rate increased, though slightly, after the injection of atropine. After 3 months of ganglioside treatment a statistically significant increase in the response to atropine was recorded. In the controls at 12 months, the response to atropine remained increased without differences between the patients treated for 3 and 12 months. The control patients did not show any modification of the heart rate response during 12 months. Both ganglioside-treated groups showed an increase in the response to propranolol. The antiGM1 titer distribution was similar in both healthy subjects and chagasic patients. None of the patients had positive antiGM1 titers in basal conditions nor significant modifications after the ganglioside treatment. Chagasic cardioneuropathy was not associated in this study with high antiGM1 antibody titers. Chagasic patients showed a diminished heart rate response to atropine as well as to propranolol. Ganglioside treatment determined an increased heart rate response, particularly after atropine. Increased heart rate response was maintained until 1 year, without differences between the patients treated for 3 and 12 months. No changes in the antiGM1 titers were observed during the ganglioside treatment.
恰加斯病会导致心脏功能受损，自主神经功能紊乱是其最早出现的改变，会影响心率和血压的控制。在此阶段，可观察到心率对阿托品和普萘洛尔的反应减弱。先前的研究表明，短期给予神经节苷脂治疗可改善对这些药物的反应，但关于神经节苷脂的长期效果以及抗GM1抗体滴度的变化情况尚无相关信息。本研究对90例（57例男性，33例女性，年龄25 - 60岁）血清学查加斯病阳性且心电图显示窦性心动过缓和不完全性右束支传导阻滞、无心脏扩大、通过体位试验和瓦尔萨尔瓦试验存在自主神经功能改变的患者，研究了长期使用神经节苷脂治疗对恰加斯病性心脏自主神经功能紊乱患者自主神经测试的影响以及抗GM1抗体滴度的变化情况。所有患者均接受一项测试，该测试包括静脉注射0.04 mg/kg阿托品，3分钟后再静脉注射0.2 mg/kg普萘洛尔。在这些测试过程中持续记录心率和血压。随后，30例患者连续15天每天肌肉注射100 mg神经节苷脂混合物，之后75天每天注射40 mg。另外30例患者接受持续12个月的治疗。其余30例患者为对照组。在治疗前、第3个月和第12个月测定抗GM1抗体的循环滴度。74例患者完成了研究。治疗前，注射阿托品后心率虽有轻微增加。神经节苷脂治疗3个月后，对阿托品的反应有统计学意义的显著增加。在对照组12个月时，对阿托品的反应仍保持增加，治疗3个月和12个月的患者之间无差异。对照患者在12个月期间心率反应未显示任何变化。两个神经节苷脂治疗组对普萘洛尔的反应均增加。健康受试者和恰加斯病患者的抗GM1滴度分布相似。所有患者在基础状态下抗GM1滴度均为阴性，神经节苷脂治疗后也无显著变化。在本研究中，恰加斯病性心脏神经病变与高抗GM1抗体滴度无关。恰加斯病患者对阿托品和普萘洛尔的心率反应均减弱。神经节苷脂治疗使心率反应增加，尤其是对阿托品的反应。心率反应增加一直维持到1年，治疗3个月和12个月的患者之间无差异。在神经节苷脂治疗期间未观察到抗GM1滴度的变化。
