Pathogenesis of hypertrophic cardiomyopathy associated with hepatitis C virus.

丙型肝炎病毒(HCV)感染在肥厚型或扩张型心肌病(HCM)或扩张型心肌病(DCM)患者中的重要性最近受到重视。在特发性心肌病研究委员会的一项合作研究项目中，在697例HCM患者中74例(10.6%)和663例DCM患者中42例(6.3%)发现了丙型肝炎病毒抗体；这一患病率显著高于日本志愿者献血者的测量结果(2.4%)。B.Maisch博士主持的一项多中心合作研究旨在测试在福尔马林固定的组织中检测肠道病毒、腺病毒、巨细胞病毒和丙型肝炎病毒等病毒基因组的重复性。尸检和活检资料采用盲法分析。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%)的心脏中发现了丙型肝炎病毒基因组，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丙型肝炎病毒基因组。β-肌动蛋白基因扩增61例(52.6%)。其中HCVRNA阳性13例(21.3%)，负链阳性4例(6.6%)。HCM组6例(26.0%)，DCM组3例(11.5%)，心肌炎组4例(33.3%)。这些丙型肝炎病毒RNA阳性标本是在1979-1990年间获得的，这表明可以从保存多年的石蜡包埋心脏中扩增出丙型肝炎病毒RNA。在与犹他大学的一项合作研究中，我们还分析了DCM的尸检心脏，发现在23例肌动蛋白基因阳性的心脏中有8例(35%)存在丙型肝炎病毒RNA。从这些心脏中回收的丙型肝炎病毒基因组序列与丙型肝炎病毒标准株高度同源。

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.