Hayashi T, Ijiri Y, Toko H, Shimomura H, Okabe M, Terasaki F, Kitaura Y, Kawamura K
The Third Division, Department of Medicine, Osaka Medical College, Takatsuki, Osaka, Japan.
Eur Heart J. 2000 Feb;21(4):296-305. doi: 10.1053/euhj.1999.1744.
Although increased digitalis-like immunoreactive substances have been found in cases of hypertension and heart failure, no information is available about digitalis-like immunoreactive substances in patients with hypertrophic cardiomyopathy. We investigated digitalis-like immunoreactive substances in the plasma and biopsied specimens of patients with hypertrophic cardiomyopathy.
In 40 patients with hypertrophic cardiomyopathy (27 with the non-obstructive type and 13 with the obstructive type), the plasma concentration of digitalis-like immunoreactive substances was studied by fluorescence polarization immunoassay. Right ventricular endomyocardial biopsy specimens were analysed immunohistochemically, using a monoclonal antibody against digoxin. An increase in digitalis-like immunoreactive substances of more than 0.2 ng. ml(-1)in plasma was found in six of 27 patients with non-obstructive hypertrophic cardiomyopathy (22.2%) and five of 13 with obstructive hypertrophic cardiomyopathy (38.4%). Under light microscopy, positive staining against the antibody was observed heterogeneously on some cardiocytes. In non-obstructive hypertrophic cardiomyopathy, digitalis-like immunoreactive substances in the plasma correlated with the left atrial dimension and inversely with the cardiac index. In obstructive hypertrophic cardiomyopathy, plasma and myocardial digitalis-like immunoreactive substances were positively correlated; they also correlated with left ventricular end-diastolic pressures. Under electron microscopy, digitalis-like immunoreactive substances were detected at the sarcolemma in the free wall, T-tubules, intercalated discs and Z-bands of cardiocytes.
Increased digitalis-like immunoreactive substances in plasma and cardiocytes, which may have been caused by pressure and/or volume overload, were found in patients with hypertrophic cardiomyopathy. Digitalis-like immunoreactive substances may act on the sarcolemma of cardiocytes and be transported into the cytoplasm.
尽管在高血压和心力衰竭患者中发现了洋地黄样免疫反应物质增加的情况，但关于肥厚型心肌病患者的洋地黄样免疫反应物质尚无相关信息。我们研究了肥厚型心肌病患者血浆和活检标本中的洋地黄样免疫反应物质。
对40例肥厚型心肌病患者（27例为非梗阻型，13例为梗阻型），采用荧光偏振免疫分析法研究血浆中洋地黄样免疫反应物质的浓度。使用抗地高辛单克隆抗体对右心室心内膜活检标本进行免疫组织化学分析。在27例非梗阻性肥厚型心肌病患者中有6例（22.2%）、13例梗阻性肥厚型心肌病患者中有5例（38.4%）血浆中洋地黄样免疫反应物质增加超过0.2 ng·ml⁻¹。在光学显微镜下，部分心肌细胞上观察到抗体阳性染色不均匀。在非梗阻性肥厚型心肌病中，血浆中洋地黄样免疫反应物质与左心房内径相关，与心脏指数呈负相关。在梗阻性肥厚型心肌病中，血浆和心肌中的洋地黄样免疫反应物质呈正相关；它们还与左心室舒张末压相关。在电子显微镜下，在心肌细胞的自由壁肌膜、T小管、闰盘和Z带处检测到洋地黄样免疫反应物质。
肥厚型心肌病患者血浆和心肌细胞中洋地黄样免疫反应物质增加，可能是由压力和/或容量超负荷引起的。洋地黄样免疫反应物质可能作用于心肌细胞膜并转运到细胞质中。
