关键词：心力衰竭；β1-受体；M2-受体
摘要：目的 本研究拟对不同心脏病所致的心力衰竭(CHF) 患者,检测心脏β1 和M2 受体的自身抗体,探讨心功能发生病理变化时,这两种自身抗体的产生与疾病发生、发展的相关性。方法　以细胞外第二环表位肽段的合成肽作为抗原,应用酶联免疫吸附测定(ELISA) 技术,随机检测265 例受试者血清中心脏β1 和M2 受体的自身抗体。结果　CHF 组β1受体自身抗体的阳性率为45.7 ％ (86/188) ,明显高于对照组的10.4 ％ (8/77) (P<0.01);CHF组M2 受体自身抗体的阳性率为49.5 ％ (93/188) ,明显高于对照组的11.7 ％ (9/77) (P<0.01);心功能Ⅱ-Ⅲ级（NYHA心功能分级）的患者自身抗体的阳性率及抗体滴度明显高于Ⅳ级;CHF组β1受体自身抗体阳性血清中高达56.1 ％的患者同时具有M2 受体的自身抗体。结论　心脏β1和M2 受体自身抗体存在于多种心脏病所致心力衰竭患者的血清中,可能与心力衰竭时心肌结构变化和功能下降有关;β1 和M2 受体的双抗体阳性可能是自身免疫反应的多重性表现,提示免疫学机制参与心力衰竭和/ 或心肌重构的病理生理过程,参与的程度在疾病的早、中期大于晚期。

Abstract:Objective：To determine whether autoantibodies against β1-adrenergic and M2-muscarinic receptors are related to patient s with conge stive heart failure (CHF).Methods：Both synthetic peptides corresponding to amino acids sequence 197 - 222 and 169 - 173 of the second extracellular loops of the β1 and M2 receptors were used a s antigens to screen sera from 265 patients. Results：Positive sera forβ1-adrenergic receptor was found in 45.73 ％ (86/188) of CHF patients , while in the controls it was 10.14％(8/77)(P<0.01);positive sera for M2-muscarinic receptor in CHF patients was found in 49.5％(99/188),while in the control it was 11.7％(9/77)(P< 0.01) . The positive ratio of autoantibodies against β1-adrenergic and M2-muscarinic receptors in CHF patient s with cardiac function Class Ⅱ-Ⅲ(NYHA) were significantly higher than cardiac function class Ⅳ.The average titer of autoantibodies against β1-adrenergic and M2-muscarinic receptors of the former was significantly higher than the latter ; 56.1 ％ of patient s with autoantibodies against β1-adrenergic receptor had autoantibodie s against M2-muscarinic receptor.Conclusions：Autoantibodies against β1-adrenergic receptor and M2-muscarinic receptor were found in sera from heart failure patients with different cardiac diseases. We propose that autoantibodie s against β1 and M2 receptors are not only related to the IDCM , but also to cardiac structural and functional changes.

    最近，有越来越多的证据暗示一种自身免疫性机制参与扩张型心肌病（IDCM）[1,2]的发病。1990-1994年间，据瑞典研究人员调查，扩张型心肌病患者的血清中存在β1 受体和M2受体的自身抗体。随后的研究表明，第二环路外的心脏G蛋白偶联是这些抗体的抗原目标。进一步研究显示，β1和M2受体自身抗体在相应受体显示其拮抗活性。因此，其具有调节心脏功能的作用。本研究通过对不同心脏病所致的心力衰竭（CHF）患者，检测心脏β1 和M2受体自身抗体，讨论这两种自身抗体与心力衰竭的相关性。