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
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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.cn112148-20231008-00263

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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。
过去,临床认识不足以及缺乏有效治疗方法,导致FD误诊率高、诊断延迟和预后差 4。随着心脏影像学的发展、基因检测的普及以及酶替代治疗(enzyme replacement therapy,ERT)等有效方法的出现,更多FD心肌病患者得到了早期诊治 5。本工作组综合国内外已发表的FD心肌病诊断与治疗的相关证据并进行严格评估和总结,为FD心肌病的管理提出共识性建议。
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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)
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