Immunosuppressive therapy of biopsy proved immune-mediated lymphocytic myocarditis in the virus-negative and virus-positive patients
Immunosuppressive therapy of biopsy proved immune-mediated lymphocytic myocarditis in the virus-negative and virus-positive patients
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DOI：
10.1016/j.carpath.2020.107260
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发表时间：
2020-11-01
影响因子：
3.7
通讯作者：
Fomin, Victor
中科院分区：
文献类型：
--
作者：
Blagova, Olga;Nedostup, Alexander;Fomin, Victor
目的：目的探讨免疫抑制治疗（IST）对病毒阴性和病毒阳性的免疫性心肌炎的疗效。60例（45例男性，46.7 ± 11.8岁，平均LV EDD，6.7 ± 0.7 cm，EF 26.2 ± 9.1%）通过心肌内膜活检证实了活动性/临界性心肌炎（n = 38），术中活检10例，心脏剖检3例，尸检9例。根据组织学、免疫活性确定IST适应症。结果：32例患者（V+组）心肌组织中检出病毒基因组，其中12例患者（V+组）心肌组织中检出病毒基因组。细小病毒B19 23例。V+和V-患者的抗心脏抗体水平同样高。24例患者接受了抗病毒治疗。IST（22例V+和24例V-患者）包括类固醇（n = 40）、羟基氯喹（n = 20）、硫唑嘌呤（n = 21）。左室EDD（6.7 ± 0.7至6.4 ± 0.8）、PAP（48.9 ± 15.5至39.4 ± 11.5 mm Hg，p
Purpose: to study the effect of immunosupressive therapy (IST) in the virus-negative and virus-positive patients with immune-mediated myocarditis.Methods: in 60 patients (45 male, 46.7 +/- 11.8 years, mean LV EDD, 6.7 +/- 0.7 cm, EF 26.2 +/- 9.1%) active/borderline myocarditis was verified by endomyocardial biopsy (n = 38), intraoperative biopsy (n = 10), examination of explanted heart (n = 3) and autopsy (n = 9). Indications for IST determined based on histological, immune activity. The follow-up was 19.0 [7.25; 40.25] months.Results: The viral genome in the myocardium was detected in 32 patients (V+ group), incl. parvovirus B19 in 23. The anti-heart antibody level was equally high in the V+ and V- patients. Antiviral therapy was administered in 24 patients. IST (in 22 V+ and 24 V- patients) include steroids (n = 40), hydroxy-chloroquine (n = 20), azathioprine (n = 21). The significant decrease of LV EDD (6.7 +/- 0.7 to 6.4 +/- 0.8), PAP (48.9 +/- 15.5 to 39.4 +/- 11.5 mm Hg, p