指南与共识
ENGLISH ABSTRACT
转甲状腺素蛋白心脏淀粉样变诊断与治疗中国专家共识
中华医学会心血管病学分会心力衰竭学组
中华心血管病杂志编辑委员会
作者及单位信息
·
DOI: 10.3760/cma.j.cn112148-20201217-00993
Chinese expert consensus on the diagnosis and treatment of transthyretin cardiac amyoidosis
Heart Failure Group of Chinese Society of Cardiology
Editorial Board of Chinese Journal of Cardiology
Zhang Shuyang
Han Yaling
Authors Info & Affiliations
Heart Failure Group of Chinese Society of Cardiology
Editorial Board of Chinese Journal of Cardiology
Zhang Shuyang
Han Yaling
·
DOI: 10.3760/cma.j.cn112148-20201217-00993
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摘要

转甲状腺素心脏淀粉样变是转甲状腺素蛋白在心肌间质外沉积所致,临床主要表现为心力衰竭和心律失常,严重影响患者的生活质量和生存率。由于该病临床表现缺乏特异性、既往缺乏无创性确诊手段和有效治疗药物,导致临床上对该病认识不足、误诊率高、诊断延迟。随着无创诊断技术的发展和有效治疗药物的问世,使得该病的早期识别、诊断和治疗成为可能,而形成相应的诊疗策略非常重要。本工作组基于国内外有关转甲状腺素心脏淀粉样变诊断与治疗的研究进展和经验,制定了符合中国诊疗常规的共识,期望能够使中国转甲状腺素蛋白心脏淀粉样变患者得到早期诊断与治疗。

淀粉样变性;心脏;前白蛋白;诊断;治疗
引用本文

中华医学会心血管病学分会心力衰竭学组,中华心血管病杂志编辑委员会. 转甲状腺素蛋白心脏淀粉样变诊断与治疗中国专家共识[J]. 中华心血管病杂志,2021,49(04):324-332.

DOI:10.3760/cma.j.cn112148-20201217-00993

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转甲状腺素蛋白心脏淀粉样变(transthyretin cardiac amyloidosis,ATTR-CA)属浸润性心肌病变,是除免疫球蛋白轻链心脏淀粉样变(immunoglobulin light chain cardiac amyloidosis,AL-CA)之外最常见的心脏淀粉样变(cardiac amyloidosis,CA) 1。转甲状腺素蛋白(transthyretin,TTR)由肝脏合成,是血中转运视黄醇结合蛋白-维生素A复合物和甲状腺素的蛋白,正常情况下为四聚体,当解离成单体并错误折叠为淀粉样物质后沉积于心肌间质时导致心肌病变,最终进展为进行性心力衰竭(心衰),即为ATTR-CA 2,也有文献称为转甲状腺素蛋白淀粉样变心肌病(transthyretin amyloid cardiomyopathy, ATTR-CM)。ATTR-CA患者生活质量差、生存率低,野生型(wild-type,ATTRwt)患者的中位生存期为诊断后43~57个月 3 , 4,突变型(mutant,ATTRm)患者的生存期取决于突变基因,其中Val122Ile突变型患者的中位生存期仅为诊断后31个月 4。ATTR-CA患者死亡原因多为心原性,包括猝死和心衰 5。本病临床认识不足、临床表现缺乏特异性、既往缺乏治疗手段,导致误诊率高、诊断延迟、预后差。随着无创诊断技术的发展和有效药物的问世,更多ATTR-CA患者得到诊治。本工作组基于国内外有关ATTR-CA诊断与治疗的研究进展和经验,制定了符合中国诊疗常规的共识,期望能够使中国ATTR-CA患者得到早期诊断与治疗。
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张抒扬,Email: mocdef.3ab61301gnahzgnayuhs
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韩雅玲,Email: tendef.3ab62gnilaynah
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