Myocarditis and heart failure associated with hepatitis C virus infection
Myocarditis and heart failure associated with hepatitis C virus infection
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DOI：
10.1016/j.cardfail.2005.11.004
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发表时间：
2006-05-01
影响因子：
6
通讯作者：
Mason, JW
中科院分区：
文献类型：
--
作者：
Matsumori, A;Shimada, T;Mason, JW
背景资料：本研究的目的是确定参加心肌炎治疗试验的患者中丙型肝炎病毒（HCV）感染和心肌损伤的患病率。HCV感染最近已注意到在心肌病和心肌炎患者。然而，HCV感染的心肌炎和心力衰竭的患病率仍有待澄清。方法和结果：心力衰竭患者长达2年的时间没有一个明确的原因参加了1986年和1990年之间的试验。从2233例入组患者中的1355例获得冷冻血液样本，并检查是否存在抗HCV抗体、循环心肌肌钙蛋白I和T以及N末端脑钠肽前体（NT-proBNP）。1355例患者中有59例（4.4%）检出抗HCV抗体。HCV感染的患病率高于在美国普通人群中观察到的患病率（1.8%），在不同的医疗中心和地区之间差异很大（0-15%）。56例患者中有17例（30%）循环心肌肌钙蛋白（cTnT）I浓度升高，59例HCV抗体阳性患者中有28例（48%）cTnT可检出，表明持续性心肌损伤。42例HCV抗体阳性患者中有42例（100%）NT-proBNP浓度升高，（10，000 +/- 5860 pg/mL），平均值显著高于1276例无HCV抗体的患者（2508 +/- 160 pg/mL，P < .0001）。结论：抗-HCV抗体在储存13 - 17年的血清中是可识别的，并且在心肌炎和HF患者中比在一般人群中更普遍。在其流行率高的地区，HCV感染可能是心肌炎和HF的重要原因。在HCV心肌炎心力衰竭患者中，NT-proBNP是比心肌肌钙蛋白更敏感的心肌损伤标志物。
Background: The aim of study is to determine the prevalence of hepatitis C virus (HCV) infection and myocardial injury among patients enrolled in the Myocarditis Treatment Trial. HCV infection has recently been noted in patients with cardiomyopathies and myocarditis. However, prevalence of HCV infection in myocarditis and heart failure remains to be clarified.Methods and Results: Patients with heart failure up to 2 years in duration without a distinct cause were enrolled in the trial between 1986 and 1990. Frozen blood samples were available from 1355 among 2233 patients enrolled and examined for presence of anti-HCV antibodies, circulating cardiac troponins I and T, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Anti-HCV antibodies were identified in 59 of 1355 patients (4.4%). This higher prevalence of HCV infection than that observed in the general US population (1.8%), varied widely (0-15%) among the different medical centers and regions. The concentrations of circulating cardiac troponin (cTn) I were elevated in 17 of 56 patients (30%), and cTnT was detectable in 28 of 59 patients (48%) with HCV antibodies, suggesting the persistence of ongoing myocardial injury. The concentrations of NT-proBNP were elevated in 42 of 42 patients (100%) with HCV antibodies, (10,000 +/- 5860 pg/mL), a mean value significantly greater than in 1276 patients without HCV antibody (2508 +/- 160 pg/mL, P < .0001).Conclusion: Anti-HCV antibodies were identifiable in sera stored for 13 to 17 years and were more prevalent in patients with myocarditis and HF than in the general population. In regions where its prevalence is high, HCV infection may be an important cause of myocarditis and HF. NT-proBNP is a more sensitive marker of myocardial injury than cardiac troponins in patients with heart failure from HCV myocarditis.