Cytomegalovirus infection of the heart is common in patients with fatal myocarditis
Cytomegalovirus infection of the heart is common in patients with fatal myocarditis
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DOI：
10.1086/427804
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发表时间：
2005-03-01
影响因子：
11.8
通讯作者：
Voipio-Pulkki, LM
中科院分区：
文献类型：
--
作者：
Kytö, V;Vuorinen, T;Voipio-Pulkki, LM
背景虽然肠道病毒和腺病毒被认为是通常轻度临床心肌炎的主要病因，但对严重或致命性心肌炎的病因知之甚少。我们收集了1970年至1998年期间芬兰心肌炎患者的所有可用临床记录和心肌尸检样本，心肌炎被记录为潜在死亡原因。所有符合达拉斯标准并有足够数据的心肌炎患者（20名男性和20名女性;中位年龄49岁）的结果均纳入本研究。12名意外死亡的受试者作为对照受试者。采用聚合酶链反应（PCR）和原位杂交技术检测心脏标本中的病毒基因组（腺病毒、巨细胞病毒、肠道病毒、人类疱疹病毒6型、甲型和B型流感病毒、细小病毒B19和鼻病毒）。在17例患者（43%）的心脏中发现病毒核酸，包括巨细胞病毒（15例）、细小病毒B19（4例）、肠道病毒（1例）和人类疱疹病毒6（1例）。在4例患者中，除了细小病毒B19或肠道病毒基因组外，还发现了巨细胞病毒DNA。在这项致死性心肌炎研究中未检测到腺病毒、鼻病毒或流感病毒。在67%的患者PCR阳性的巨细胞病毒，原位杂交显示心肌细胞中的病毒DNA。这些患者中只有1例免疫功能低下。对照组仅检出1例人类疱疹病毒6型和1例细小病毒B19型DNA。在这项基于人群的研究中，巨细胞病毒被发现是免疫功能正常的致命性心肌炎患者中最常见的特异性发现。这可能对重症急性心肌炎的治疗具有重要的临床意义。
Background. Although enteroviruses and adenoviruses are considered to be the leading causes of the usually mild clinical myocarditis, little is known about the etiology of severe or fatal myocarditis.Methods. We collected all available clinical records and myocardial autopsy samples for patients who had myocarditis recorded as the underlying cause of death in Finland during the period of 1970-1998. Findings for all available patients (20 men and 20 women; median age, 49 years) with myocarditis that fulfilled the Dallas criteria and who had sufficient data were included in the study. Twelve subjects who had died accidentally served as control subjects. Polymerase chain reaction (PCR) and in situ hybridization assays were used for detection of viral genomes (adenovirus, cytomegalovirus, enterovirus, human herpesvirus 6, influenza A and B viruses, parvovirus B19, and rhinovirus) in heart samples.Results. Viral nucleic acids were found in the hearts of 17 patients (43%), including cytomegalovirus (15 patients), parvovirus B19 (4 patients), enterovirus (1 patient), and human herpesvirus 6 (1 patient). In 4 patients, cytomegalovirus DNA was found in addition to parvovirus B19 or enterovirus genomes. No adenoviruses, rhinoviruses, or influenza viruses were detected in this study of fatal myocarditis. In 67% of the patients for whom PCR was positive for cytomegalovirus, in situ hybridization revealed viral DNA in cardiomyocytes. Only 1 of these patients was immunocompromised. In the control group, only human herpesvirus 6 (1 subject) and parvovirus B19 (1 subject) DNA were detected.Conclusions. In this population-based study, cytomegalovirus was found to be the most common specific finding in immunocompetent patients with fatal myocarditis. This may have important clinical implications for the treatment of severe acute myocarditis.