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Las inmunoglobulinas y la estructura y función del ventrículo izquierdo en la infección pediátrica por VIH
S E Lipshultz1, E J Orav, S P Sanders
1Department of Cardiology, Children's Hospital, Boston, MA 02115, USA.
Circulation
|October 15, 1995
Resumen
El tratamiento intravenoso de inmunoglobulina (IVIG) y los niveles más altos de inmunoglobulina IgG mejoran la estructura y la función del ventrículo izquierdo (LV) en niños con VIH. Esto sugiere que la modulación inmune puede ayudar a tratar la disfunción cardíaca relacionada con el VIH.
Área de la Ciencia:
- Cardiología Pediátrica Cardiología pediátrica.
- Enfermedades infecciosas Enfermedades infecciosas.
- Inmunología Inmunología.
Sus antecedentes:
- La dilatación progresiva del ventrículo izquierdo (LV) es común en la infección pediátrica por VIH-1, lo que puede conducir a la insuficiencia cardíaca congestiva (ICC).
- La disfunción de LV en estos niños a menudo está relacionada con una hipertrofia inadecuada, una carga posterior elevada y una función reducida.
- Observaciones anteriores sugieren que la insuficiencia cardíaca congestiva puede mejorar con inmunoglobulina intravenosa (IVIG) en otras condiciones.
Objetivo del estudio:
- Investigar la relación entre los niveles de inmunoglobulina y la estructura/función de LV en niños infectados por el VIH sin CHF.
- Para explorar la base inmunológica potencial de la disfunción de LV en el VIH pediátrico.
Principales métodos:
- Análisis retrospectivo de 49 lactantes infectados por el VIH y niños sin CHF.
- 106 ecocardiogramas realizados dentro de los 30 días de las mediciones de inmunoglobulina sérica (IgG, IgA, IgM).
- Análisis de regresión de medidas repetidas ajustado por edad, superficie corporal y otros factores clínicos.
Principales resultados:
- Los niveles más altos de IgG endógena y el tratamiento IVIG se correlacionaron con un aumento del grosor de la pared de LV y una disminución de la tensión máxima de la pared.
- Los niveles elevados de IgA endógena se asociaron con un espesor de pared de LV más normalizado y relaciones espesor-dimensión.
- Se observó una tendencia hacia una mejor contractilidad de LV, acortamiento fraccionado y estrés de pared sistólica final con niveles más altos de inmunoglobulina o terapia IVIG.
Conclusiones:
- La estructura y la función de LV están más normalizadas en niños infectados por el VIH que reciben IVIG o con niveles más altos de IgG endógenos.
- Estos hallazgos apoyan la hipótesis de que el deterioro del crecimiento miocárdico y la disfunción de LV en el VIH pediátrico están mediados inmunológicamente.
- La terapia inmunomoduladora, como IVIG, puede ser beneficiosa para el manejo de la disfunción de LV en esta población.
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