A CLINICOPATHOLOGICAL DESCRIPTION OF MYOCARDITIS
A CLINICOPATHOLOGICAL DESCRIPTION OF MYOCARDITIS
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DOI：
10.1006/clin.1993.1117
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发表时间：
1993-08-01
期刊：
影响因子：
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通讯作者：
BAUGHMAN, KL
中科院分区：
文献类型：
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作者：
LIEBERMAN, EB;HERSKOWITZ, A;BAUGHMAN, KL
心肌炎的组织学证据显示，在35 348例患者提交内膜心肌活检超过5年。分析这些患者的组织学表现和临床病程，得出了一个新的心肌炎临床病理分类，其中确定了四个不同的亚组。暴发性心肌炎患者在明显的病毒前驱症状后急性发病，有严重的心血管损害，组织学研究发现有多个活动性心肌炎病灶，心室功能障碍可自发消退或导致死亡。急性、慢性活动性和慢性持续性心肌炎患者的发病不太明显。急性心肌炎患者表现为明确的心室功能障碍，可能对免疫抑制治疗有反应，或者他们的病情可能进展为扩张型心肌病。那些患有慢性活动性心肌炎的患者最初对免疫抑制治疗有反应，但他们具有临床和组织学复发，并发展与慢性炎症变化相关的心室功能障碍，包括组织学研究中的巨细胞。慢性持续性心肌炎的特征是持续的组织学浸润，通常伴有心肌细胞坏死灶，但无心室功能障碍，尽管有其他心血管症状，如胸痛或心悸。
Histologic evidence of myocarditis was demonstrated in 35 of 348 patients submitted to endomyocardial biopsy over 5 years. Analysis of the histologic findings and clinical course of these patients resulted in a new clinicopathologic classification of myocarditis in which four distinct subgroups are identified. Patients with fulminant myocarditis become acutely ill after a distinct viral prodrome, have severe cardiovascular compromise, multiple foci of active myocarditis by histologic study and ventricular dysfunction that either resolves spontaneously or results in death. Patients with acute, chronic active and chronic persistent myocarditis have a less distinct onset of illness.Patients with acute myocarditis present with established ventricular dysfunction and may respond to immunosuppressive therapy or their condition may progress to dilated cardiomyopathy. Those with chronic active myocarditis initially respond to immunosuppressive therapy, but they have clinical and histologic relapses and develop ventricular dysfunction associated with chronic inflammatory changes including giant cells on histologic study. Chronic persistent myocarditis is characterized by a persistent histologic infiltrate, often with foci of myocyte necrosis but without ventricular dysfunction despite other cardiovascular symptoms such as chest pain or palpitation.