Rodeles Luz M, Vicco Miguel H, Bontempi Iván A, Siano Alvaro, Tonarelli Georgina, Bottasso Oscar A, Arias Pablo, Marcipar Iván S
Laboratory of Immunological Techniques, National University of Littoral, Santa Fe, Argentina.
Internal Medicine Department, National University of Littoral, Santa Fe, Argentina.
Trop Med Int Health. 2016 Dec;21(12):1545-1551. doi: 10.1111/tmi.12791. Epub 2016 Oct 24.
Autoantibodies cross-reacting with the β1 adrenergic receptor (anti-β1AR and anti-p2β) and cardiac myosin antigens (anti-B13) have been related to the pathogenesis of chronic Chagas heart disease (CCHD). Studies exploring their levels in different stages are scarce. We aimed to evaluate the relationship of these autoantibodies with the clinical profile of chronic patients, especially regarding their classificatory accuracy in severe presentation with heart failure.
We conducted a cross-sectional study of 155 T. cruzi-seropositive patients and 26 age- and gender-matched healthy controls. They were categorised in three stages of CCHD. Serum antibodies were measured by specific immunoassays. Symptomatic individuals showed increased levels of anti-β1AR and anti-B13, while anti-p2β antibodies were similar between groups. A composite logistic regression model including anti-B13, anti-β1AR antibody levels and age was able to predict systolic heart failure yielding an area under the curve of 83% (sensitivity of 67% and specificity of 89%).
In our study, anti-β1AR and anti-B13 antibodies were higher in individuals with chronic Chagas heart disease stage III, mainly in those with dilated cardiomyopathy associated with systolic heart failure. Logistic regression analysis showed that both antibodies were good predictors of severe CCHD. As well as being involved in disease progression, anti-β1AR and anti-B13 antibodies may be used as a serum marker of poor prognosis in terms of heart compromise.
与β1肾上腺素能受体发生交叉反应的自身抗体（抗β1AR和抗p2β）以及心肌肌球蛋白抗原（抗B13）与慢性恰加斯心脏病（CCHD）的发病机制有关。探索它们在不同阶段水平的研究很少。我们旨在评估这些自身抗体与慢性患者临床特征的关系，特别是它们在心力衰竭严重表现中的分类准确性。
我们对155名克氏锥虫血清阳性患者和26名年龄及性别匹配的健康对照进行了横断面研究。他们被分为CCHD的三个阶段。通过特异性免疫测定法测量血清抗体。有症状的个体抗β1AR和抗B13水平升高，而抗p2β抗体在各组之间相似。一个包括抗B13、抗β1AR抗体水平和年龄的综合逻辑回归模型能够预测收缩性心力衰竭，曲线下面积为83%（敏感性为67%，特异性为89%）。
在我们的研究中，慢性恰加斯心脏病III期患者的抗β1AR和抗B13抗体较高，主要是那些伴有收缩性心力衰竭的扩张型心肌病患者。逻辑回归分析表明，这两种抗体都是严重CCHD的良好预测指标。抗β1AR和抗B13抗体除了参与疾病进展外，在心脏损害方面还可作为预后不良的血清标志物。
