Mechanism of the pathogenesis of myocarditis and cardiomyopathy due to hepatitis C virus

53例扩张型心肌病患者血清中有8例（15.1%）存在丙型肝炎病毒抗体，66例肥厚型心肌病患者血清中有11例（13.8%）存在丙型肝炎病毒抗体，而日本自愿献血者对照人群中有2.4%存在丙型肝炎病毒抗体，差异有统计学意义（p<0.0001）。在肥厚性心肌病中，9例患者中有5例血清中存在1b型丙型肝炎病毒RNA。丙型肝炎病毒拷贝数为5.5 × 10^3 ~ 8.6 × 10^5个基因组/ml血清，每个患者血清中均检测到丙型肝炎病毒的多个克隆。在6例患者心脏中发现丙型肝炎病毒阳性链，2例患者心脏中发现阴性链。作为一项合作研究项目，我们发出了一份调查问卷，以调查丙型肝炎病毒感染与心肌病之间可能存在的联系。697例肥厚型心肌病患者（平均年龄57.7岁）中74例（10.6%）和663例扩张型心肌病患者（平均年龄56.5岁）中42例（6.3%）检测到丙型肝炎病毒抗体；这些患病率明显高于日本的志愿献血者（2.4%，50-59岁，p<0.0001）。肥厚型心肌病患者的患病率明显高于扩张型心肌病患者（p<0.01）。在5所学术医院就诊的11,967名患者中，有650人（5.4%）检测出肝炎病毒抗体。丙型肝炎病毒抗体阳性的患者出现多种心脏异常，心律失常最为常见。这些观察结果表明，丙型肝炎病毒感染是各种其他无法解释的心脏病的重要原因。

Anti-hepatitis C virus antibody was present in the sera of 8 of 53 patients (15.1%) with dilated cardiomyopathy and 11 of 66 patients (13.8%) with hypertrophic cardiomyopathy, versus 2.4% in control population of voluntary blood donors in Japan, a statistically significant difference (p<0.0001). In hypertrophic cardiomyopathy, type 1b hepatitis C virus RNA was present in the sera of 5 of the 9 patients. The copy number of hepatitis C virus was 5.5x10^3to8.6x10^5 genomes/ml serum, and multiple clones of hepatitis C virus were detected in the sera of each patient. Positive strands of hepatitis C virus were found in the hearts of 6 patients, and negative strands in the hearts of 2 patients.As a collaborative research project, a questionnaire was sent out to examine the possible association between hepatitis C virus infection and cardiomyopathies. Hepatitis C virus antibody was found in 74 of 697 patients (10.6%) with hypertrophic cardiomyopathy (mean age, 57.7 years) and in 42 of 663 patients (6.3%) with dilated cardiomyopathy (mean age, 56.5 years) ; these prevalences were significantly higher than that found in volunteer blood donors in Japan (2.4%, 50-59 years of age, each p<0.0001). The prevalence was significantly higher in patients suffering from hypertrophic cardiomyopathy as opposed to those with dilated cardiomyopathy (p<0.01). Presence of hepatitis virus antibody was detected in 650 of 11,967 patients (5.4%) seeking care in 5 academic hospitals. Various cardiac abnormalities were found among these patients with positive anti-hepatitis C virus antibody, arrhythmias being the most frequent. These observations suggest that hepatitis C virus infection is an important cause of a variety of otherwise unexplained heart diseases.