Pathogenesis of hypertrophic cardiomyopathy associated with hepatitis C virus.

丙型肝炎病毒（hepatitis C virus，HCV）感染在肥厚型心肌病（hypertrophic cardiomyopathy，HCM）或扩张型心肌病（difficult cardiomyopathy，DCM）患者中的重要性近年来受到关注，在特发性心肌病研究委员会的一项合作研究中，697例患者中有74例检测到HCV抗体663例HCM患者中有42例（10.6%）DCM组为6.3%;这一患病率明显高于日本志愿献血者的测量值（2.4%）。由B.Maisch博士主持的一项合作性多中心研究，用于测试病毒基因组检测的重现性，如肠道病毒，腺病毒，福尔马林固定组织中的巨细胞病毒和HCV。对尸检和活检材料进行盲法分析。在来自意大利的11名扩张型心肌病和心肌炎患者中有2名（18%）和来自美国的11名患者中有4名（36%）的心脏中发现了丙型肝炎病毒基因组。我们试图在尸检心脏的石蜡切片中检测HCV基因组。在106例心脏中，61例（52.6%）有β-actin基因扩增。其中13例（21.3%）检出HCVRNA，4例（6.6%）为阴性。HCM组6例（26.0%），DCM组3例（11.5%），心肌炎组4例（33.3%）。这些HCV RNA阳性样本是在1979年至1990年之间获得的，表明HCV RNA可以从保存多年的石蜡包埋心脏中扩增。我们还在与犹他州大学的合作研究中分析了患有DCM的尸检心脏，在23个肌动蛋白基因阳性的心脏中有8个（35%）发现了HCV RNA。从这些心脏中回收的HCV基因组序列与HCV标准株高度同源。

The importance of hepatitis C virus (HCV) infection has recently been noted in patients with hypertrophic cardiomyopathy (HCM) or dilated cardiomyopathy (DCM).In a collaborative research project of the Committees for the Study of Idiopathic Cardiomyopathy, HCV antibody was found in 74 of 697 patients (10.6%) with HCM and in 42 of 663 patients (6.3%) with DCM; this prevalence was significantly higher than measured in volunteer blood donors in Japan (2.4%).A collaborative multicenter study, chaired by Dr.B.Maisch, was performed to test the reproducibility of detection of detection of viral genomes such as enteroviruses, adenovirus, cytomegalovirus and HCV in formalin fixed tissues. Autopsy and biopsy materials were analyzed blindly. Hepatitis C virus genomes were found in the hearts of 2 out of 11 patients (18%) with dilated cardiomyopathy and myocarditis from Italy, and 4 out of 11 patients (36%) from the United States. We attempted to detect HCV genomes in paraffin sections of autopsied hearts. Among 106 hearts examined, β-actin gene was amplified in 61 hearts (52.6%). Among these, HCV RNA was detected in 13 hearts (21.3%), and negative strands in 4 hearts (6.6%). HCV RNA was found in 6 hearts (26.0%) with HCM, 3 heart (11.5%) with DCM, and 4 hearts (33.3%) with myocarditis. These HCV RNA positive samples were obtained between 1979 and 1990, indicating that HCV RNA can be amplified from paraffin-embedded hearts preserved for many years. We also analyzed autopsied hearts with DCM in a collaborative research with the University of Utah, and found HCV RNA in 8 of 23 hearts (35%) with positive actin genes. The sequences of HCV genomes recovered from these hearts were closely homologous to the standard strain of HCV.