首页 中华心血管病杂志 2024年52卷02期 成人法布雷病心肌病诊断与治疗中国专家共识
中华心血管病杂志
期刊首页
过刊列表
高级检索
稿件发表
• 指南与共识 •
ENGLISH ABSTRACT
成人法布雷病心肌病诊断与治疗中国专家共识
中华医学会心血管病学分会
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.cn112148-20231008-00263
Chinese expert consensus on the diagnosis and treatment of adult Fabry disease cardiomyopathy
Chinese Society of Cardiology, Chinese Medical Association
Editorial Board of Chinese Journal of Cardiology
Zhang Shuyang
Han Yaling
Authors Info & Affiliations
Chinese Society of Cardiology, Chinese Medical Association
Editorial Board of Chinese Journal of Cardiology
Zhang Shuyang
Han Yaling
·
DOI: 10.3760/cma.j.cn112148-20231008-00263
0
0
0
0
0
0
扫描转手机阅读
下载中华医学期刊APP阅读更流畅 体验更丰富
PDF下载
APP内阅读
摘要
法布雷病(FD)是一种X染色体连锁遗传疾病,因GLA基因突变,导致其编码的α半乳糖苷酶A(α-Gal A)活性降低或完全缺乏,造成代谢底物三己糖酰基鞘(Gb3)及衍生物脱乙酰基Gb3(Lyso-Gb3)在多种细胞和组织中贮积,引起多脏器病变。在心血管系统中,FD主要会导致左心室肥厚和(或)传导异常,即FD心肌病。由于FD心肌病是FD成人患者死亡的主要原因,因此结合心脏影像学、酶和底物活性、基因检测以及组织活检等方法的早期诊断,以及早期特异性酶替代疗法对于改善患者预后非常重要。本共识综合总结国内外已发表的FD心肌病诊断与治疗的相关证据,为FD心肌病的诊断与管理提供依据。
法布雷病;心肌病;诊断;治疗
引用本文
中华医学会心血管病学分会,中华心血管病杂志编辑委员会. 成人法布雷病心肌病诊断与治疗中国专家共识[J]. 中华心血管病杂志,2024,52(02):128-136.
DOI:10.3760/cma.j.cn112148-20231008-00263PERMISSIONS
Request permissions for this article from CCC.
评价本文
*以上评分为匿名评价
本文评分
5分
[累计个]
向我们报错
版权归中华医学会所有。
未经授权,不得转载、摘编本刊文章,不得使用本刊的版式设计。
除非特别声明,本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。
法布雷病(Fabry disease,FD),又称Anderson-Fabry病(Anderson-Fabry disease),因位于Xq22.1的GLA基因突变,导致其编码的α半乳糖苷酶A(α-galactosidase A,α-Gal A)活性降低或完全缺乏,造成代谢底物三己糖酰基鞘脂醇(Globotriaosylceramides,Gb3)以及衍生物脱乙酰基Gb3(globotriaosylsphingosine,Lyso-Gb3)在神经、皮肤、肾脏和心脏等组织中大量贮积,引起多脏器病变和相应临床表现
[
1
]
。Gb3和Lyso-Gb3沉积在心血管系统的多种细胞内,导致包括左心室肥厚(left ventricular hypertrophy,LVH)、传导异常、主动脉瓣及二尖瓣关闭不全等多种表现
[
2
]
。由于FD的心脏受累主要表现为LVH伴/不伴传导异常,本共识也主要侧重于FD导致的LVH、传导异常和心功能不全的诊治,将这种FD心脏受累定义为FD心肌病。FD心肌病是FD患者死亡的主要原因
[
3
]
,早期诊断与治疗对于改善患者预后非常重要。
试读结束,您可以通过登录机构账户或个人账户后获取全文阅读权限。
已是订阅账户?
登录
参考文献
[1]
中国法布雷病专家协作组. 中国法布雷病诊疗专家共识(2021年版)[J]. 中华内科杂志, 2021,60(4):321-330. DOI:
10.3760/cma.j.cn112138-20201218-01028
.
[2]
Pieroni M , Moon JC , Arbustini E ,et al. Cardiac involvement in Fabry disease: JACC review topic of the week[J]. J Am Coll Cardiol, 2021,77(7):922-936. DOI:
10.1016/j.jacc.2020.12.024
.
[3]
Nordin S , Kozor R , Medina-Menacho K ,et al. Proposed stages of myocardial phenotype development in fabry disease[J]. JACC Cardiovasc Imaging, 2019,12(8Pt 2):1673-1683. DOI:
10.1016/j.jcmg.2018.03.020
.
[4]
Patel V , O′Mahony C , Hughes D ,et al. Clinical and genetic predictors of major cardiac events in patients with Anderson-Fabry Disease[J]. Heart, 2015,101(12):961-966. DOI:
10.1136/heartjnl-2014-306782
.
[5]
Yim J , Yau O , Yeung DF ,et al. Fabry Cardiomyopathy: current practice and future directions[J]. Cells, 2021,10(6):1532. DOI:
10.3390/cells10061532
.
[6]
Patel MR , Cecchi F , Cizmarik M ,et al. Cardiovascular events in patients with fabry disease natural history data from the fabry registry[J]. J Am Coll Cardiol, 2011,57(9):1093-1099. DOI:
10.1016/j.jacc.2010.11.018
.
[7]
O′Mahony C , Elliott P . Anderson-Fabry disease and the heart[J]. Prog Cardiovasc Dis, 2010,52(4):326-335. DOI:
10.1016/j.pcad.2009.11.002
.
[8]
Xiao Y , Sun Y , Tian T ,et al. Prevalence and clinical characteristics of Fabry disease in Chinese patients with hypertrophic cardiomyopathy[J]. Am J Med Sci, 2021,362(3):260-267. DOI:
10.1016/j.amjms.2021.01.009
.
[9]
Doheny D , Srinivasan R , Pagant S ,et al. Fabry disease: prevalence of affected males and heterozygotes with pathogenic GLA mutations identified by screening renal, cardiac and stroke clinics, 1995-2017[J]. J Med Genet, 2018,55(4):261-268. DOI:
10.1136/jmedgenet-2017-105080
.
[10]
Nowicki M , Bazan-Socha S , Błażejewska-Hyzorek B ,et al. Enzyme replacement therapy in Fabry disease in Poland: a position statement[J]. Pol Arch Intern Med, 2020,130(1):91-97. DOI:
10.20452/pamw.15117
.
[11]
王朝晖,潘晓霞,陈楠. 提高对法布里病临床表现和实验室新指标的认识[J]. 诊断学理论与实践, 2014,13(1):20-23. DOI:
10.3969/j.issn.1671-2870.2014.01.006
.
[12]
Favalli V , Disabella E , Molinaro M ,et al. Genetic screening of Anderson-Fabry disease in probands referred from multispecialty clinics[J]. J Am Coll Cardiol, 2016,68(10):1037-1050. DOI:
10.1016/j.jacc.2016.05.090
.
[13]
Mehta A , Clarke JT , Giugliani R ,et al. Natural course of Fabry disease: changing pattern of causes of death in FOS-Fabry Outcome Survey[J]. J Med Genet, 2009,46(8):548-552. DOI:
10.1136/jmg.2008.065904
.
[14]
Yousef Z , Elliott PM , Cecchi F ,et al. Left ventricular hypertrophy in Fabry disease: a practical approach to diagnosis[J]. Eur Heart J, 2013,34(11):802-808. DOI:
10.1093/eurheartj/ehs166
.
[15]
[16]
Namdar M . Electrocardiographic changes and arrhythmia in Fabry disease[J]. Front Cardiovasc Med, 2016,3:7. DOI:
10.3389/fcvm.2016.00007
.
[17]
Akhtar MM , Elliott PM . Anderson-Fabry disease in heart failure[J]. Biophys Rev, 2018,10(4):1107-1119. DOI:
10.1007/s12551-018-0432-5
.
[18]
El-Abassi R , Singhal D , England JD . Fabry′s disease[J]. J Neurol Sci, 2014,344(1-2):5-19. DOI:
10.1016/j.jns.2014.06.029
.
[19]
Kampmann C , Wiethoff CM , Martin C ,et al. Electrocardiographic signs of hypertrophy in fabry disease-associated hypertrophic cardiomyopathy[J]. Acta Paediatr Suppl, 2002,91(439):21-27. DOI:
10.1111/j.1651-2227.2002.tb03105.x
.
[20]
Baig S , Vijapurapu R , Alharbi F ,et al. Diagnosis and treatment of the cardiovascular consequences of Fabry disease[J]. QJM, 2019,112(1):3-9. DOI:
10.1093/qjmed/hcy120
.
[21]
Ortiz A , Germain DP , Desnick RJ ,et al. Fabry disease revisited: management and treatment recommendations for adult patients[J]. Mol Genet Metab, 2018,123(4):416-427. DOI:
10.1016/j.ymgme.2018.02.014
.
[22]
Tower-Rader A , Jaber WA . Multimodality imaging assessment of Fabry disease[J]. Circ Cardiovasc Imaging, 2019,12(11):e009013. DOI:
10.1161/CIRCIMAGING.119.009013
.
[23]
Shanks M , Thompson RB , Paterson ID ,et al. Systolic and diastolic function assessment in fabry disease patients using speckle-tracking imaging and comparison with conventional echocardiographic measurements[J]. J Am Soc Echocardiogr, 2013,26(12):1407-1414. DOI:
10.1016/j.echo.2013.09.005
.
[24]
Krämer J , Niemann M , Liu D ,et al. Two-dimensional speckle tracking as a non-invasive tool for identification of myocardial fibrosis in Fabry disease[J]. Eur Heart J, 2013,34(21):1587-1596. DOI:
10.1093/eurheartj/eht098
.
[25]
Perry R , Shah R , Saiedi M ,et al. The role of cardiac imaging in the diagnosis and management of Anderson-Fabry Disease[J]. JACC Cardiovasc Imaging, 2019,12(7Pt 1):1230-1242. DOI:
10.1016/j.jcmg.2018.11.039
.
[26]
Weidemann F , Beer M , Kralewski M ,et al. Early detection of organ involvement in Fabry disease by biomarker assessment in conjunction with LGE cardiac MRI: results from the SOPHIA study[J]. Mol Genet Metab, 2019,126(2):169-182. DOI:
10.1016/j.ymgme.2018.11.005
.
[27]
Hagège A , Réant P , Habib G ,et al. Fabry disease in cardiology practice: Literature review and expert point of view[J]. Arch Cardiovasc Dis, 2019,112(4):278-287. DOI:
10.1016/j.acvd.2019.01.002
.
[28]
Hanneman K , Karur GR , Wasim S ,et al. Left ventricular hypertrophy and late gadolinium enhancement at cardiac MRI are associated with adverse cardiac events in Fabry disease[J]. Radiology, 2020,294(1):42-49. DOI:
10.1148/radiol.2019191385
.
[29]
Torralba-Cabeza MÁ , Olivera S , Hughes DA ,et al. Cystatin C and NT-proBNP as prognostic biomarkers in Fabry disease[J]. Mol Genet Metab, 2011,104(3):301-307. DOI:
10.1016/j.ymgme.2011.06.021
.
[30]
Andrade J , Waters PJ , Singh RS ,et al. Screening for Fabry disease in patients with chronic kidney disease: limitations of plasma alpha-galactosidase assay as a screening test[J]. Clin J Am Soc Nephrol, 2008,3(1):139-145. DOI:
10.2215/CJN.02490607
.
[31]
Nakagawa N , Sawada J , Sakamoto N ,et al. High-risk screening for Anderson-Fabry disease in patients with cardiac, renal, or neurological manifestations[J]. J Hum Genet, 2019,64(9):891-898. DOI:
10.1038/s10038-019-0633-1
.
[32]
Schiffmann R , Hughes DA , Linthorst GE ,et al. Screening, diagnosis, and management of patients with Fabry disease: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) controversies conference[J]. Kidney Int, 2017,91(2):284-293. DOI:
10.1016/j.kint.2016.10.004
.
[33]
Sakuraba H , Togawa T , Tsukimura T ,et al. Plasma lyso-Gb3: a biomarker for monitoring fabry patients during enzyme replacement therapy[J]. Clin Exp Nephrol, 2018,22(4):843-849. DOI:
10.1007/s10157-017-1525-3
.
[34]
Politei J , Alberton V , Amoreo O ,et al. Clinical parameters, LysoGb3, podocyturia, and kidney biopsy in children with Fabry disease: is a correlation possible?[J]. Pediatr Nephrol, 2018,33(11):2095-2101. DOI:
10.1007/s00467-018-4006-3
.
[35]
Aerts JM , Groener JE , Kuiper S ,et al. Elevated globotriaosylsphingosine is a hallmark of Fabry disease[J]. Proc Natl Acad Sci U S A, 2008,105(8):2812-2817. DOI:
10.1073/pnas.0712309105
.
[36]
Auray-Blais C , Ntwari A , Clarke JT ,et al. How well does urinary lyso-Gb3 function as a biomarker in Fabry disease?[J]. Clin Chim Acta, 2010,411(23-24):1906-1914. DOI:
10.1016/j.cca.2010.07.038
.
[37]
Nowak A , Mechtler T , Kasper DC ,et al. Correlation of Lyso-Gb3 levels in dried blood spots and sera from patients with classic and Later-Onset Fabry disease[J]. Mol Genet Metab, 2017,121(4):320-324. DOI:
10.1016/j.ymgme.2017.06.006
.
[38]
Cairns T , Müntze J , Gernert J ,et al. Hot topics in Fabry disease[J]. Postgrad Med J, 2018,94(1118):709-713. DOI:
10.1136/postgradmedj-2018-136056
.
[39]
Sawada T , Kido J , Yoshida S ,et al. Newborn screening for Fabry disease in the western region of Japan[J]. Mol Genet Metab Rep, 2020,22:100562. DOI:
10.1016/j.ymgmr.2019.100562
.
[40]
Hwu WL , Chien YH , Lee NC ,et al. Newborn screening for Fabry disease in Taiwan reveals a high incidence of the later-onset GLA mutation c.936+919G>A (IVS4+919G>A)[J]. Hum Mutat, 2009,30(10):1397-1405. DOI:
10.1002/humu.21074
.
[41]
Oder D , Liu D , Hu K ,et al. α-Galactosidase A genotype N215S induces a specific cardiac variant of Fabry disease[J]. Circ Cardiovasc Genet, 2017,10(5):e001691. DOI:
10.1161/CIRCGENETICS.116.001691
.
[42]
San Román-Monserrat I , Moreno-Flores V , López-Cuenca D ,et al. Comprehensive clinical evaluation of a large Spanish family with Anderson-Fabry disease, novel GLA mutation and severe cardiac phenotype[J]. Med Clin (Barc), 2014,142(11):497-504. DOI:
10.1016/j.medcli.2014.01.032
.
[43]
Csányi B , Hategan L , Nagy V ,et al. Identification of a novel GLA Gene mutation, p.Ile239Met, in Fabry disease with a predominant cardiac phenotype[J]. Int Heart J, 2017,58(3):454-458. DOI:
10.1536/ihj.16-361
.
[44]
Linhart A , Germain DP , Olivotto I ,et al. An expert consensus document on the management of cardiovascular manifestations of Fabry disease[J]. Eur J Heart Fail, 2020,22(7):1076-1096. DOI:
10.1002/ejhf.1960
.
[45]
Hsu TR , Chang FP , Chu TH ,et al. Correlations between endomyocardial biopsies and cardiac manifestations in Taiwanese patients with the Chinese hotspot IVS4+919G>a mutation: data from the Fabry outcome survey[J]. Int J Mol Sci, 2017,18(1):119. DOI:
10.3390/ijms18010119
.
[46]
Weidemann F , Maier SK , Störk S ,et al. Usefulness of an implantable loop recorder to detect clinically relevant arrhythmias in patients with advanced Fabry cardiomyopathy[J]. Am J Cardiol, 2016,118(2):264-274. DOI:
10.1016/j.amjcard.2016.04.033
.
[47]
Zeppenfeld K , Tfelt-Hansen J , de Riva M ,et al. 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death[J]. Eur Heart J, 2022,43(40):3997-4126. DOI:
10.1093/eurheartj/ehac262
.
[48]
Baig S , Edward NC , Kotecha D ,et al. Ventricular arrhythmia and sudden cardiac death in Fabry disease: a systematic review of risk factors in clinical practice[J]. Europace, 2018,20(FI2):f153-f161. DOI:
10.1093/europace/eux261
.
[49]
Rob D , Marek J , Dostalova G ,et al. Heart failure in Fabry disease revisited: application of current heart failure guidelines and recommendations[J]. ESC Heart Fail, 2022,9(6):4043-4052. DOI:
10.1002/ehf2.14091
.
[50]
Yancy CW , Jessup M , Bozkurt B ,et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. J Am Coll Cardiol, 2013,62(16):e147-239. DOI:
10.1016/j.jacc.2013.05.019
.
[51]
Bernardes TP , Foresto RD , Kirsztajn GM . Fabry disease: genetics, pathology, and treatment[J]. Rev Assoc Med Bras (1992), 2020,66Suppl 1(Suppl 1):s10-s16. DOI:
10.1590/1806-9282.66.S1.10
.
[52]
Simonetta I , Tuttolomondo A , Daidone M ,et al. Treatment of Anderson-Fabry Disease[J]. Curr Pharm Des, 2020,26(40):5089-5099. DOI:
10.2174/1381612826666200317142412
.
[53]
Caballero L , Climent V , Hernández-Romero D ,et al. Enzyme replacement therapy in Fabry disease: influence on cardiac manifestations[J]. Curr Med Chem, 2010,17(16):1679-1689. DOI:
10.2174/092986710791111297
.
[54]
Beck M , Hughes D , Kampmann C ,et al. Long-term effectiveness of agalsidase alfa enzyme replacement in Fabry disease: A Fabry Outcome Survey analysis[J]. Mol Genet Metab Rep, 2015,3:21-27. DOI:
10.1016/j.ymgmr.2015.02.002
.
[55]
Kampmann C , Perrin A , Beck M . Effectiveness of agalsidase alfa enzyme replacement in Fabry disease: cardiac outcomes after 10 years′ treatment[J]. Orphanet J Rare Dis, 2015,10:125. DOI:
10.1186/s13023-015-0338-2
.
[56]
Gaggl M , Sunder-Plassmann G . Fabry disease: a pharmacological chaperone on the horizon[J]. Nat Rev Nephrol, 2016,12(11):653-654. DOI:
10.1038/nrneph.2016.138
.
备注信息
A
张抒扬,Email:
mocdef.3ab61301gnahzgnayuhs
B
韩雅玲,Email:
tendef.3ab62gnilaynah
C
中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 成人法布雷病心肌病诊断与治疗中国专家共识[J]. 中华心血管病杂志, 2024, 52(2): 128-136. DOI: 10.3760/cma.j.cn112148-20231008-00263.
D
所有作者声明无利益冲突
E
国家重点研发计划 (2022YFC2703100) 
中国医学科学院医学与健康科技创新工程 (2021-I2M-1-003) 
雄安新区科技创新专项 (2023XAGG0069) 
评论 (0条)
注册 登录
时间排序
- 时间排序
暂无评论,发表第一条评论抢沙发
分享
详细信息
表
访问与引文
阅读权限
参考文献
访问与引用
访问数据
0
0
全部时间 最近30天 最近6个月 最近12个月
MedAI助手(体验版)
回答内容由人工智能生成,我社无法保证其准确性和完整性,该生成内容不代表我们的态度或观点,仅供参考。
生成快照
文献快照
文献快照
N/A
N/A
AI总结中

N/A
N/A
快照内容由人工智能生成,供您参考。

你好,我可以帮助您更好的了解本文,请向我提问您关注的问题。
0/50
很抱歉,当前对话已达到其限制。
使用"新建对话"按钮开启更多对话。
停止回答
0/2000
信息反馈
中文(简体)
英文
翻译
机器翻译功能由科大讯飞提供技术支持
回答内容由人工智能生成,我社无法保证其准确性和完整性,该生成内容不代表我们的态度或观点,仅供参考。

你好! 今天我能为您提供什么帮助?
0/30
of
很抱歉,当前对话已达到其限制。
使用"新建对话"按钮开启更多对话。
停止回答
扩写 缩写 改写 翻译
0/2000
信息反馈
历史对话
本文全部
还没有聊天记录
设置
模式
纯净模式沉浸模式
字号
小中大
翻译
润色
扩写
缩写
复制
引用