Department of Medicine B and Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel.
Heart. 2010 Oct;96(19):1518-24. doi: 10.1136/hrt.2010.195255.
Autoimmunity plays a role in the pathogenesis of numerous cardiac diseases such as dilated cardiomyopathy (DCM), myocarditis, rheumatic fever and atherosclerosis. An autoimmune response may appear following myocardial injury and exposure to self-antigens. Anti-heart autoantibodies have been identified in patients with heart disease and in low titres of healthy individuals. Troponin is the preferred marker in detecting acute coronary syndrome. In recent years, anti-troponin autoantibodies were identified in patients with DCM and ischaemic cardiomyopathy. The presence of anti-troponin autoantibodies in the serum may cause a false-negative evaluation of troponin levels and delay treatment of acute coronary syndrome. The role of anti-troponin autoantibodies in humans and their possible involvement in the pathogenesis of heart disease remains controversial. Previous studies have demonstrated that anti-troponin autoantibodies can cause cardiac dysfunction in animal models. This paper reviews current knowledge on anti-troponin autoantibodies. Future research should focus on the pathogenic role of anti-troponin autoantibodies and reactive T cells and the possible benefits of targeted therapy in acute coronary syndrome, post-myocardial infarction, myocarditis, DCM and heart failure.
自身免疫在许多心脏疾病的发病机制中起作用，如扩张型心肌病（DCM）、心肌炎、风湿热和动脉粥样硬化。自身免疫反应可能在心肌损伤和暴露于自身抗原后出现。在心脏病患者和健康个体的低滴度中已发现抗心脏自身抗体。肌钙蛋白是检测急性冠状动脉综合征的首选标志物。近年来，在 DCM 和缺血性心肌病患者中发现了抗肌钙蛋白自身抗体。血清中存在抗肌钙蛋白自身抗体可能导致肌钙蛋白水平的假阴性评估，并延迟急性冠状动脉综合征的治疗。抗肌钙蛋白自身抗体在人类中的作用及其在心脏病发病机制中的可能参与仍存在争议。先前的研究表明，抗肌钙蛋白自身抗体可在动物模型中引起心脏功能障碍。本文综述了抗肌钙蛋白自身抗体的现有知识。未来的研究应集中在抗肌钙蛋白自身抗体和反应性 T 细胞的致病作用以及靶向治疗在急性冠状动脉综合征、心肌梗死后、心肌炎、DCM 和心力衰竭中的可能益处。
