基于心肌活检的扩张型心肌病患者分类与治疗

Myocardial biopsy based classification and treatment in patients with dilated cardiomyopathy.

作者信息

Zimmermann Oliver, Kochs Matthias, Zwaka Thomas Paul, Kaya Ziya, Lepper Philipp Moritz, Bienek-Ziolkowski Magdalena, Hoher Martin, Hombach Vinzenz, Torzewski Jan

机构信息

Department of Internal Medicine II-Cardiology, University of Ulm, Robert-Koch-Str. 8, 89081 Ulm, Germany.

出版信息

Int J Cardiol. 2005 Sep 15;104(1):92-100. doi: 10.1016/j.ijcard.2005.02.052.

DOI:10.1016/j.ijcard.2005.02.052

PMID:16137516

Abstract

BACKGROUND

We investigated whether myocardial biopsy analysis for inflammation and viruses correlates with outcome in dilated cardiomyopathy.

METHODS

Myocardial biopsies of 82 patients were analyzed for HLAI, HLAII, CD54, CD2, CD68 and entero-/adenovirus. Ejection fraction was determined by left ventriculography. NYHA classification, electrocardiogram (ECG) and echocardiography were analyzed at first admission and for follow up. Patients were attributed to three groups: (A) no inflammation/no virus (B) inflammation/no virus (C) virus with/without inflammation. Patients not responding to conventional treatment of heart failure received interferon beta1b (group C) or prednisolone (group B). Median follow up was 7 months (group A), 11 months (group B) and 14.5 months (group C).

RESULTS

Thirty nine patients (48%) belonged to group A, 33 patients (40%) to group B, 10 patients (12%) to group C. Only enterovirus was detected. Ejection fraction at admission was worse for group B compared to group A (p=0.003). Groups A and B improved for echocardiography and NYHA (p< or =0.001). Group C improved for echocardiography only (p=0.031). Group B showed a better outcome for echocardiography (p=0.014) and NYHA (p=0.023) than group A.

CONCLUSIONS

Inflammatory cardiomyopathy shows the best outcome. Antiinflammatory or antiviral treatment may be an option in patients not responding to conventional therapy.

摘要

背景

我们研究了扩张型心肌病患者心肌活检的炎症及病毒检测结果与预后是否相关。

方法

对82例患者的心肌活检样本进行HLAI、HLAII、CD54、CD2、CD68及肠道/腺病毒检测。通过左心室造影测定射血分数。首次入院及随访时分析纽约心脏协会（NYHA）分级、心电图（ECG）及超声心动图结果。患者分为三组：（A）无炎症/无病毒；（B）有炎症/无病毒；（C）有病毒伴/不伴炎症。对常规心力衰竭治疗无反应的患者接受干扰素β1b（C组）或泼尼松龙（B组）治疗。中位随访时间为：A组7个月，B组11个月，C组14.5个月。

结果

39例患者（48%）属于A组，33例患者（40%）属于B组，10例患者（12%）属于C组。仅检测到肠道病毒。与A组相比，B组入院时射血分数更差（p = 0.003）。A组和B组超声心动图及NYHA分级改善（p≤0.001）。C组仅超声心动图有所改善（p = 0.031）。B组超声心动图（p = 0.014）及NYHA分级（p = 0.023）预后较A组好。