Kuethe Friedhelm, Sigusch Holger H, Hilbig Kristina, Tresselt Christiane, Glück Brigitte, Egerer Renate, Figulla Hans R
Klinik fuer Innere Medizin I, Friedrich-Schiller-Universitaet Jena, Jena, Germany.
Am Heart J. 2007 May;153(5):850-8. doi: 10.1016/j.ahj.2007.02.013.
The presence of viral genome in the myocardium of patients with dilated cardiomyopathy (DCM) has been suggested as causative for the underlying cardiac disease. Nevertheless, the results of present studies are conflicting regarding the natural course of heart diseases associated with detection of viral genome. This study was undertaken to determine if the detection of viral genome in the myocardium of patients with DCM is of functional and prognostic relevance under modern treatment strategies of heart insufficiency.
In 197 patients with DCM, left ventricular endomyocardial biopsies were performed. Analysis for genome of adenovirus, enterovirus (EV), and parvovirus B19 as well as enteroviral replication and immunohistology was performed.
The increase in ejection fraction (EF) was 14.5 +/- 12.4% in the EV-positive group compared with 11.1 +/- 14.2 in the EV-negative group (P = not significant [NS]) after a mean follow-up (FU) of 19.5 and 17.6 months. The increase in EF in the virus-positive group (positive for EV, adenovirus, or parvovirus B19) was 15.3 +/- 13.3% compared with 12.3 +/- 11.9% in the virus-negative group (P = NS) after a mean FU of 17.6 and 11.5 months. There was no significant difference in the change of EF between the EV-positive and virus-negative groups. Detection of enteroviral RNA replication (detection of EV minus-strand RNA) did not result in a deterioration of left ventricular function compared with the virus-negative group (P = NS) after mean FU of 11.2 and 12.0 months. The transplantation-free survival of the patients was not influenced by detection of viral genome.
Our results favor the view that the presence of viral genome in the myocardium of patients with DCM is of no functional and prognostic relevance.
扩张型心肌病（DCM）患者心肌中病毒基因组的存在被认为是潜在心脏病的病因。然而，目前关于与病毒基因组检测相关的心脏病自然病程的研究结果相互矛盾。本研究旨在确定在现代心力衰竭治疗策略下，DCM患者心肌中病毒基因组的检测是否具有功能和预后相关性。
对197例DCM患者进行左心室心内膜活检。对腺病毒、肠道病毒（EV）和细小病毒B19的基因组以及肠道病毒复制和免疫组织学进行分析。
在平均随访19.5个月和17.6个月后，EV阳性组射血分数（EF）增加14.5±12.4%，而EV阴性组为11.1±14.2%（P=无显著差异[NS]）。在平均随访17.6个月和11.5个月后，病毒阳性组（EV、腺病毒或细小病毒B19阳性）的EF增加为15.3±13.3%，而病毒阴性组为12.3±11.9%（P=NS）。EV阳性组和病毒阴性组之间EF变化无显著差异。在平均随访11.2个月和12.0个月后，与病毒阴性组相比，肠道病毒RNA复制检测（EV负链RNA检测）未导致左心室功能恶化（P=NS）。患者的无移植生存率不受病毒基因组检测的影响。
我们的结果支持以下观点，即DCM患者心肌中病毒基因组的存在与功能和预后无关。
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