Department of Cardiology, Kitasato Institute Hospital, Kitasato University School of Medicine, Tokyo, Japan.
Circ J. 2010 Jul;74(7):1372-8. doi: 10.1253/circj.cj-09-0748. Epub 2010 May 22.
Cardiodepressant IgG3 autoantibodies (CD-Abs) can be targeted by apheresis. Using blinded measurements of CD-Abs before and after immunoadsorption (IA), the cardiac function of patients who did or did not achieve complete CD-Abs elimination was compared.
Autoantibodies were completely removed from 18 patients with heart failure (New York Heart Association class 3 or 4, left ventricular ejection fraction (LVEF) <30%) using a selective IgG3 adsorption column. All patients had anti-beta1-adrenergic and/or M2-muscarinic autoantibodies before IA, and all LVEF were measured on radionuclide ventriculography. CD-Abs were measured before and after IA, and patient status was blinded until all measurements were collected. Treatment was defined as complete when CD-Abs status changed from positive to negative after IA. Other instances were defined as incomplete. Six-min walk test results and brain natriuretic peptide levels improved significantly after IA (P<0.01). The increase in LVEF 3 months after IA was significantly greater after complete treatment in comparison to the incomplete treatment group (19+/-8-29+/-9% vs 18+/-9-17+/-8%, P<0.01). Cardiac insufficiency events were also more frequent in the incomplete treatment group.
Complete elimination of CD-Abs with apheresis may be related to improved cardiac function in the treatment of heart failure.
心肌抑制 IgG3 自身抗体 (CD-Abs) 可通过血浆分离术靶向治疗。通过对免疫吸附 (IA) 前后 CD-Abs 的盲测，比较了完全清除 CD-Abs 和未完全清除 CD-Abs 的患者的心脏功能。
采用选择性 IgG3 吸附柱从 18 例心力衰竭患者 (纽约心脏协会分级 3 或 4 级，左心室射血分数 (LVEF) <30%) 中完全清除自身抗体。所有患者在 IA 前均存在抗β1-肾上腺素能和/或 M2-毒蕈碱自身抗体，所有 LVEF 均通过放射性核素心室造影术测量。IA 前后均测量 CD-Abs，患者状态在所有测量完成前保持盲态。当 IA 后 CD-Abs 状态从阳性变为阴性时，将治疗定义为完全清除。其他情况定义为不完全清除。IA 后 6 分钟步行试验结果和脑钠肽水平显著改善 (P<0.01)。与不完全清除治疗组相比，完全清除治疗组 3 个月后 LVEF 的增加更显著 (19+/-8%-29+/-9%比 18+/-9%-17+/-8%，P<0.01)。不完全清除治疗组也更频繁发生心力衰竭事件。
用血浆分离术完全清除 CD-Abs 可能与心力衰竭治疗中心脏功能的改善有关。
