Lipshultz S E, Orav E J, Sanders S P, Colan S D
Department of Cardiology, Children's Hospital, Boston, MA 02115, USA.
Circulation. 1995 Oct 15;92(8):2220-5. doi: 10.1161/01.cir.92.8.2220.
Progressive left ventricular (LV) dilation is common in children infected with HIV-1 and may be a harbinger of congestive heart failure (CHF). In many HIV-infected children, dilation is associated with inadequate LV hypertrophy, elevated afterload, and reduced LV function. Because CHF has been observed empirically to improve after treatment with intravenous immunoglobulin (IVIG) in other conditions and because LV dysfunction in pediatric HIV may be immunologically mediated, we examined retrospectively the relation between immunoglobulins and LV structure and function in 49 HIV-infected infants and children without CHF.
A total of 106 echocardiograms were performed in these children within 30 days of serum immunoglobulin (IgG, IgA, and IgM) measurements; this includes 12 children treated with IVIG therapy. All echocardiographic parameters, blood pressures, and immunoglobulins were adjusted for age or body surface area and subjected to repeated-measures regression. Regression models were adjusted simultaneously for endogenous IgA, IgG, IgM, IVIG therapy, zidovudine therapy, age, HIV disease stage, and weight. Higher endogenous serum IgG levels and IVIG treatment were associated with significantly greater wall thickness and lower peak wall stress. Higher endogenous serum IgA levels were associated with more normal LV wall thickness and LV thickness-to-dimension ratios. LV contractility, fractional shortening, end-systolic wall stress, and thickness-to-dimension ratio all showed a trend toward more normal values with higher endogenous immunoglobulin values or during IVIG treatment.
LV structure and function appear to be more normal in HIV-infected children who receive IVIG treatment and in those with higher endogenous IgG levels. These results suggest that both the impaired myocardial growth and the LV dysfunction observed may be immunologically mediated and responsive to immunomodulatory therapy.
进行性左心室（LV）扩张在感染HIV-1的儿童中很常见，可能是充血性心力衰竭（CHF）的先兆。在许多感染HIV的儿童中，扩张与左心室肥厚不足、后负荷升高和左心室功能降低有关。由于在其他情况下经验性观察到CHF在静脉注射免疫球蛋白（IVIG）治疗后有所改善，并且由于儿科HIV患者的左心室功能障碍可能是免疫介导的，我们回顾性研究了49例无CHF的感染HIV的婴儿和儿童中免疫球蛋白与左心室结构和功能之间的关系。
在这些儿童进行血清免疫球蛋白（IgG、IgA和IgM）测量的30天内，共进行了106次超声心动图检查；这包括12例接受IVIG治疗的儿童。所有超声心动图参数、血压和免疫球蛋白均根据年龄或体表面积进行调整，并进行重复测量回归分析。回归模型同时针对内源性IgA、IgG、IgM、IVIG治疗、齐多夫定治疗、年龄、HIV疾病阶段和体重进行了调整。较高的内源性血清IgG水平和IVIG治疗与明显更大的室壁厚度和更低的室壁峰值应力相关。较高的内源性血清IgA水平与更正常的左心室壁厚度和左心室厚度与内径比值相关。随着内源性免疫球蛋白值升高或在IVIG治疗期间，左心室收缩力、缩短分数、收缩末期室壁应力和厚度与内径比值均呈现出趋向更正常数值的趋势。
接受IVIG治疗的感染HIV儿童以及内源性IgG水平较高的儿童，其左心室结构和功能似乎更正常。这些结果表明，观察到的心肌生长受损和左心室功能障碍可能都是免疫介导的，并且对免疫调节治疗有反应。
