Viral myocarditis: balance between viral infection and immune response.
Viral myocarditis: balance between viral infection and immune response.
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发表时间：
1996-10
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通讯作者：
Peter Liu;Tami A. Martino;M. Opavsky;Josef M. Penninger
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作者：
Peter Liu;Tami A. Martino;M. Opavsky;Josef M. Penninger
心肌炎是心肌的炎症性疾病，在临床实践中经常被诊断不足。它在患有急性心力衰竭的年轻人中表现得更为明显，而在患有慢性扩张型心肌病的成人中表现得更为隐蔽。在北美，其病因最常见的是病毒性的，具有广泛的自然史。大多数患者会自然康复，但那些患有持续性心室功能障碍的患者一年死亡率高达 20%。心肌炎始于病毒性疾病，分子技术已证实病毒的持续存在。免疫反应是一把双刃剑——免疫反应不足和过度都会导致疾病。最后，肌细胞是上述过程的目标，并表达导致扩张型心肌病和心力衰竭的分子、细胞因子和血管变化。诊断的金标准仍然依赖于过于严格的达拉斯标准来评估心肌活检。分子技术在诊断和预后中发挥着越来越重要的作用。临床怀疑仍然是早期诊断的关键。治疗必须是早期和持续的——最初通常是支持性的，现在免疫抑制在延缓免疫反应旺盛的患者方面发挥着次要作用。扩张型心肌病的新疗法，如氨氯地平和卡维地洛，同样适用于心肌炎后患者。未来的治疗可能涉及特定的生物制剂、免疫疗法、抗病毒策略和分子基因疗法。
Myocarditis is an inflammatory disorder of the heart muscle, and is often underdiagnosed in clinical practice. It presents more dramatically in the young with acute heart failure and more insidiously in adults with chronic dilated cardiomyopathy. The etiology is most often viral in North America, with a wide spectrum of natural history. The majority of patients recover spontaneously, but those with persistent ventricular dysfunction face a 20% one-year mortality. Myocarditis initiates as viral disease, and molecular techniques have confirmed viral persistence. The immune response follows as a two-edged sword-both inadequate and excessive immune responses lead to disease. Finally, the myocyte is the target of the above processes, and expresses molecular, cytokine and vascular changes that lead to dilated cardiomyopathy and heart failure. The gold standard for diagnosis still relies on the overly strict Dallas criteria for evaluating myocardial biopsies. Molecular techniques are playing an increasingly important role in both diagnosis and prognosis. Clinical suspicion is still the key towards an early diagnosis. Treatment must be early and persistent-generally supportive initially, with immunosuppression now playing a secondary role in temporizing those with exuberant immune response. Newer treatments for dilated cardiomyopathy such as amlodipine and carvedilol are equally appropriate for postmyocarditis patients. Future treatment may involve specific biological agents, immune therapy, antiviral strategies and molecular gene therapy.