Aukrust Pål, Yndestad Arne, Ueland Thor, Damås Jan Kristian, Frøland Stig S, Gullestad Lars
Research Institute for Internal Medicine, Rikshospitalet University Hospital, University of Oslo, N-0027 Oslo, Norway.
Int J Cardiol. 2006 Sep 10;112(1):40-5. doi: 10.1016/j.ijcard.2006.05.015. Epub 2006 Aug 8.
Chronic heart failure (HF), including both ischemic and idiopathic dilated cardiomyopathies, is accompanied by a dysregulated cytokine network characterized not only by a rise in inflammatory cytokines, but also by an inadequate elevation of anti-inflammatory mediators. This dysregulation has been implicated in the development and progression of chronic HF, and in the last decade, attempts have been made to modulate this persistent inflammation. Failure of anti-tumor necrosis factor therapy in HF has led to further interest in a more general immunomodulatory approach, directed against the inflammatory imbalance rather than one particular cytokine. Treatment with intravenous immunoglobulin (IVIg) may represent such a broad-based approach trying to restore the dysregulated cytokine network through various mechanisms such as Fc receptor blockade, neutralization of microbial antigens and superantigens and more direct anti-inflammatory effects on the cytokine network. However, although one randomized placebo-controlled study in patients with chronic HF showed that IVIg improved left ventricular ejection fraction, accompanied by anti-inflammatory net effects, IVIg had no effect in another placebo-controlled study examining the effect of this medication in recent-onset cardiomyopathy. So far, few patients have been included in clinical trials, and there is clearly a need for larger placebo-controlled mortality studies involving a diverse group of patients with regard to cause and severity of HF.
慢性心力衰竭（HF），包括缺血性和特发性扩张型心肌病，伴有细胞因子网络失调，其特征不仅在于炎性细胞因子升高，还在于抗炎介质升高不足。这种失调与慢性HF的发生和发展有关，在过去十年中，人们试图调节这种持续的炎症。HF中抗肿瘤坏死因子治疗的失败引发了人们对一种更普遍的免疫调节方法的进一步关注，该方法针对的是炎症失衡而非一种特定的细胞因子。静脉注射免疫球蛋白（IVIg）治疗可能代表了这样一种广泛的方法，即试图通过各种机制恢复失调的细胞因子网络，如Fc受体阻断、微生物抗原和超抗原的中和以及对细胞因子网络更直接的抗炎作用。然而，尽管一项针对慢性HF患者的随机安慰剂对照研究表明，IVIg改善了左心室射血分数，并伴有抗炎净效应，但在另一项研究该药物对近期发病心肌病影响的安慰剂对照研究中，IVIg没有效果。到目前为止，很少有患者被纳入临床试验，显然需要开展更大规模的安慰剂对照死亡率研究，纳入不同病因和严重程度的HF患者群体。
