Pauschinger Matthias, Chandrasekharan Kumaran, Noutsias Michel, Kühl Uwe, Schwimmbeck Lothar Peter, Schultheiss Heinz-Peter
Department of Cardiology, Medical Clinic II, Charité, University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
Med Microbiol Immunol. 2004 May;193(2-3):65-9. doi: 10.1007/s00430-003-0213-y. Epub 2004 Jan 14.
Myocarditis is considered as a potent predisposing factor for dilated cardiomyopathy (DCM). Molecular biological proof of viral genome and immunohistochemical evaluation of intramyocardial inflammation are substantial in the identification and diagnosis of this pathological condition. Viruses are generally thought to be the common causative agents that trigger myocarditis and, therefore, several investigations are indispensable for the detection of viral genome in the myocardium in diagnosing viral myocarditis. The era of molecular diagnosis for viral myocarditis began with the establishment of the slot blot hybridization technique for the detection of viral genome in endomyocardial biopsy specimens. Due to inherent technical inadequacies, this method soon was replaced by in situ hybridization and polymerase chain reaction (PCR). Although in situ hybridization combines both morphological and molecular diagnosis, difficulty in standardization, possibility of nonspecific hybridization, and focal viral infection have led PCR to be an ideal molecular diagnostic strategy for the detection of viral myocarditis. Despite controversies over the specificity of this technique, several studies have substantiated the use of PCR in virological diagnosis. The ability to detect the state of viral replicative activity by demonstrating the presence of enteroviral minus-strand RNA has added a new dimension to studies on viral etiology of myocarditis and DCM. Advances in molecular diagnosis have indicated beyond doubt that persistence of viral infection is associated with disease deterioration and poor prognosis. Viral etiology of myocarditis and its contribution to the development of DCM have suggested antiviral therapy for myocarditis and DCM patients with proven viral infection.
心肌炎被认为是扩张型心肌病（DCM）的一个重要诱发因素。病毒基因组的分子生物学证据和心肌内炎症的免疫组织化学评估对于这种病理状况的识别和诊断至关重要。病毒通常被认为是引发心肌炎的常见病原体，因此，在诊断病毒性心肌炎时，对心肌中病毒基因组的检测进行多项调查是必不可少的。病毒性心肌炎的分子诊断时代始于用于检测心内膜活检标本中病毒基因组的狭缝印迹杂交技术的建立。由于其固有的技术不足，该方法很快被原位杂交和聚合酶链反应（PCR）所取代。尽管原位杂交结合了形态学和分子诊断，但标准化困难、非特异性杂交的可能性以及局灶性病毒感染使得PCR成为检测病毒性心肌炎的理想分子诊断策略。尽管对该技术的特异性存在争议，但多项研究证实了PCR在病毒学诊断中的应用。通过证明肠道病毒负链RNA的存在来检测病毒复制活性状态的能力为心肌炎和DCM的病毒病因学研究增添了新的维度。分子诊断的进展毫无疑问地表明，病毒感染的持续存在与疾病恶化和预后不良有关。心肌炎的病毒病因及其对DCM发展的作用提示了对已证实病毒感染的心肌炎和DCM患者进行抗病毒治疗。
