Clinical significance of chronic myocarditis: systematic review and meta-analysis.
Clinical significance of chronic myocarditis: systematic review and meta-analysis.
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慢性心肌炎的临床意义：系统评价和荟萃分析。
DOI：
10.1007/s00380-021-01914-y
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Imanaka-Yoshida K.
中科院分区：
文献类型：
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作者：
Hirono K;Takarada S;Okabe M;Miyao N;Nakaoka H;Ibuki K;Ozawa S;Origasa H;Ichida F;Imanaka-Yoshida K.
慢性心肌炎是心肌中的一种长期炎症状态，其组织学表现由炎性浸润的存在定义。慢性心肌炎尚未被广泛了解，其治疗慢性心肌炎尚未建立。本研究的主要结局是评估除常规治疗外免疫调节治疗的疗效，次要结局是明确扩张型心肌病（DCM）患者慢性心肌炎自然史的预后和慢性心肌炎的发生率。我们检索了Medline、Embase、科克伦对照试验中央登记中心和Igaku Chuo Zasshi在1946年1月至2020年6月期间发表的研究。16项研究符合纳入标准。一项荟萃分析显示，与对照组相比，接受免疫调节治疗的患者显示免疫调节治疗后左心室射血分数改善（风险比，16.65;置信区间，4.55-28.74;p= 0.007）。炎性扩张型（iDCM）和扩张型（DCM）患者的5年生存率分别为52.7-70.3%和51.9- 91.1%。此外，51.5%-62.7%的DCM患者符合iDCM的标准。我们的系统回顾显示，慢性心肌炎患者预后差，除常规治疗外，免疫调节治疗显著有效。
Chronic myocarditis is a prolonged inflammatory condition in the myocardium and its histological manifestation is defined by the presence of an inflammatory infiltrate. Chronic myocarditis has not been well known and its treatment of chronic myocarditis has not been established. Primary outcome of this study was to assess the efficacy of immunomodulatory treatment in addition to conventional treatment, and secondary outcomes were to clarity the prognosis of natural history of chronic myocarditis and incidence of chronic myocarditis in patients with dilated cardiomyopathy (DCM). We searched for studies in Medline, Embase, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi published between January 1946 and June 2020. Sixteen studies met the inclusion criteria. A meta-analysis revealed that patients receiving immunomodulatory treatment showed an improvement in left ventricular ejection fraction after immunomodulatory treatment compared to the control group (hazard ratio, 16.65; confidence interval, 4.55–28.74;p= 0.007). Five-year survival rate of the patients with inflammatory DCM (iDCM) and DCM was 52.7–70.3% and 51.9–91.1%, respectively. Moreover, 51.5%–62.7% of patients with DCM met the criteria of iDCM. Our systematic review revealed that patients with chronic myocarditis had poor prognosis and immunomodulatory treatment was significantly effective in addition to conventional treatment.