母乳喂养、细胞免疫激活与围产期心肌病的心肌恢复

Koczo Agnes, Marino Amy, Jeyabalan Arun, Elkayam Uri, Cooper Leslie T, Fett James, Briller Joan, Hsich Eileen, Blauwet Lori, McTiernan Charles, Morel Penelope A, Hanley-Yanez Karen, McNamara Dennis M

University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

University of Southern California, Los Angeles, California.

JACC Basic Transl Sci. 2019 Jun 24;4(3):291-300. doi: 10.1016/j.jacbts.2019.01.010. eCollection 2019 Jun.

The etiology of peripartum cardiomyopathy remains unknown. One hypothesis is that an increase in the 16-kDa form of prolactin is pathogenic and suggests that breastfeeding may worsen peripartum cardiomyopathy by increasing prolactin, while bromocriptine, which blocks prolactin release, may be therapeutic. An autoimmune etiology has also been proposed. The authors investigated the impact of breastfeeding on cellular immunity and myocardial recovery for women with peripartum cardiomyopathy in the IPAC (Investigations in Pregnancy Associated Cardiomyopathy) study. Women who breastfed had elevated prolactin, and prolactin levels correlated with elevations in CD8 T cells. However, despite elevated prolactin and cytotoxic T cell subsets, myocardial recovery was not impaired in breastfeeding women.

围产期心肌病的病因仍然不明。一种假说认为，16 kDa形式的催乳素增加具有致病性，这表明母乳喂养可能通过增加催乳素而使围产期心肌病恶化，而抑制催乳素释放的溴隐亭可能具有治疗作用。也有人提出自身免疫病因。作者在IPAC（妊娠相关性心肌病研究）中调查了母乳喂养对围产期心肌病女性细胞免疫和心肌恢复的影响。母乳喂养的女性催乳素水平升高，且催乳素水平与CD8 T细胞升高相关。然而，尽管催乳素和细胞毒性T细胞亚群升高，但母乳喂养的女性心肌恢复并未受损。