Evaluation of viral infection in the myocardium of patients with idiopathic dilated cardiomyopathy
Evaluation of viral infection in the myocardium of patients with idiopathic dilated cardiomyopathy
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DOI：
10.1016/s0735-1097(00)00955-4
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发表时间：
2000-11-15
影响因子：
24
通讯作者：
Shimizu, A
中科院分区：
文献类型：
--
作者：
Fujioka, S;Kitaura, Y;Shimizu, A
本研究的目的是评估病毒病因学的特发性扩张型心肌病（DCM）。背景的演示，肠道病毒基因组在心脏与DCM加强了重要性，肠道病毒在DCM的发病机制。然而，在心肌中检测到的肠道病毒的特征和活性存在不确定性。方法对26例原发性扩张型心肌病患者行左心室部分切除术（PLV）后的心肌标本进行病毒学检测。进行肠道病毒RNA的链特异性检测以区分活跃的病毒复制和潜伏的持续性。用聚合酶链反应（PCR）检测丙型肝炎病毒、腺病毒、巨细胞病毒、流感病毒、腮腺炎病毒、单纯疱疹病毒、水痘带状疱疹病毒和EB病毒的基因组序列。在这9例正链RNA阳性患者中，有7例（78%）确定了负链肠道病毒RNA。序列分析显示，检测到的肠道病毒均为科萨基B病毒，如柯萨奇B3和B4病毒。然而，没有检测到其他病毒的遗传物质。7例肠道负链病毒RNA阳性患者中有6例（86%）在PLV后的前6个月内死于心功能不全。结论科萨基B病毒见于特发性DCM的心脏。活跃的病毒RNA复制似乎存在于这些病例的显著比例中。心肌中的柯萨奇病毒负链RNA可作为PLV后临床预后不良的标志。没有证据表明DCM心脏中存在其他病毒的持续感染。(C)2000年，美国心脏病学会。
OBJECTIVES The aim of this study was to evaluate the viral etiology of idiopathic dilated cardiomyopathy (DCM).BACKGROUND The demonstration of enteroviral genome in hearts with DCM has reinforced the importance of enteroviruses in the pathogenesis of DCM. However, there is uncertainty about the character and activity of enteroviruses detected in the myocardium. Recently, the association of hepatitis C virus or adenovirus with DCM has been reported.METHODS Myocardial specimens from 26 patients with idiopathic DCM, which were obtained at partial left ventriculectomy (PLV), were examined virologically. Strand-specific detection of enteroviral RNA was performed to differentiate active viral replication from latent persistence. Polymerase chain reaction was used to detect genomic sequences of hepatitis C virus, adenovirus, cytomegalovirus, influenza viruses, mumps virus, herpes simplex viruses, varicellazoster virus and Epstein-Barr virus.RESULTS Plus-strand enteroviral RNA was detected in 9 (35%) of the 26 patients. Minus-strand enteroviral RNA was determined in seven (78%) of these nine plus-strand RNA-positive patients. Sequence analysis revealed that the enteroviruses detected were coxsackie B viruses, such as coxsackievirus B3 and B4. However, genetic material from other viruses was not detected. Six (86%) of seven minus-strand enteroviral RNA-positive patients died of cardiac insufficiency within the first six months after PLV.CONCLUSIONS Coxsackie B viruses were seen in hearts with idiopathic DCM. Active viral RNA replication appeared to be present in a significant proportion of these cases. Minus-strand coxsackieviral RNA in the myocardium can be a marker for poor clinical outcome after PLV. There was no evidence of persistent infection by other viruses in hearts with DCM. (C) 2000 by the American College of Cardiology.