THE MORPHOLOGICAL PROGRESSION OF VIRAL MYOCARDITIS
THE MORPHOLOGICAL PROGRESSION OF VIRAL MYOCARDITIS
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DOI：
10.1136/pgmj.62.728.581
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发表时间：
1986-06-01
影响因子：
5.1
通讯作者：
TAZELAAR, HD
中科院分区：
文献类型：
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作者：
BILLINGHAM, ME;TAZELAAR, HD
为了记录从急性特发性心肌炎到终末期扩张型心肌病的形态学进展，我们研究了20例诊断为心肌炎的患者，他们进行了连续的心肌炎内膜活检，间隔1个月至2年，年龄从6个月到62岁不等。其中15例患者使用免疫抑制药物治疗心肌炎。15例患者中有10例临床稳定。其余5例充血性心力衰竭加重，1例行心脏移植。在未接受免疫抑制的5例患者中，2例自行稳定，3例发生心力衰竭，其中2例随后进行了心脏移植。无论患者是否接受免疫抑制，所有病例炎症浸润均减少，但心肌明显肥大，间质纤维化增加，8例形态学改变为扩张型心肌病。从形态学的角度来看，我们已经证明扩张型心肌病可能是急性心肌炎的最终结果。似乎并不是每个急性心肌炎都会发展为扩张型心肌病，类固醇治疗也不一定能防止心肌炎发展为扩张型心肌病。
In an attempt to document the morphological progression from acute idiopathic myocarditis to end-stage dilated cardiomyopathy we studied 20 patients with a diagnosis of myocarditis who had had serial endomyocardial biopsies performed with intervals of 1 month to 2 years and whose ages varied from 6 months to 62 years. Fifteen of these patients were treated with immunosuppressive drugs for myocarditis. Ten out of 15 treated patients stabilized clinically. In the remaining 5 cases there was worsening congestive heart failure and 1 patient underwent cardiac transplantation. Of the 5 patients who did not receive immunosuppression, 2 stabilized spontaneously, and 3 developed heart failure, 2 of whom subsequently had cardiac transplants. Whether the patients received immunosuppression or not, in all cases, the inflammatory infiltrate was less but the myocardium developed significant hypertrophy with an increase in interstitial fibrosis and in 8 cases the morphological changes were those of dilated cardiomyopathy.From the morphological standpoint of this study we have shown some evidence that dilated cardiomyopathy can be the end result of acute myocarditis. It appears that not every case of acute myocarditis progresses to dilated cardiomyopathy and that steroid treatment does not necessarily prevent progression of myocarditis to dilated cardiomyopathy.