Maisch B, Outzen H, Roth D, Hiby A, Herzum M, Hengstenberg C, Hufnagel G, Schönian U, Kochsiek K
Department of Internal Medicine-Cardiology, Marburg, Germany.
Eur Heart J. 1991 Aug;12 Suppl D:81-7. doi: 10.1093/eurheartj/12.suppl_d.81.
In this study from two specialized centres 85 patients with histologically proven myocarditis (n = 10) and clinically ascertained perimyocarditis (pericardial effusion and cardiomegaly or segmental wall motion abnormality; n = 75) were followed up for 4.5 + 1.9 years. Immunosuppressive treatment was not applied. After a mean follow-up period of 4.5 + 1.9 years 55% of patients had improved clinically and 35% of patients were completely free of symptoms. Relapses had occurred up to three times. Chronic forms were found in 20% of patients, mostly in those with pericarditis and effusions. Eighteen percent of the patients deteriorated gradually. In 20% of the chronic or deteriorating patients congestive heart failure developed (postmyocarditic heart muscle disease). Fifteen percent of the patients died, mainly from bacterial perimyocarditis and to a lesser extent from inflammatory heart disease from enteroviruses. Patients who succumbed after more than 6 months died either suddenly or from progressive heart failure. A favourable outcome was often accompanied by a decrease in titre, but this decrease was less impressive in those who had antimyolemmal and antisarcolemmal antibodies. The persistence of these antibodies in high titres predominated in patients with poor prognosis and postmyocarditic dilated heart muscle disease, as did cytolytic serum activity.
在这项来自两个专业中心的研究中，85例经组织学证实的心肌炎患者（n = 10）和临床确诊的心肌心包炎患者（心包积液、心脏扩大或节段性室壁运动异常；n = 75）接受了4.5±1.9年的随访。未进行免疫抑制治疗。平均随访4.5±1.9年后，55%的患者临床症状改善，35%的患者完全无症状。复发最多发生3次。20%的患者出现慢性形式，主要是心包炎和积液患者。18%的患者病情逐渐恶化。在20%的慢性或病情恶化患者中发生了充血性心力衰竭（心肌炎后心肌疾病）。15%的患者死亡，主要死于细菌性心肌心包炎，其次是肠道病毒引起的炎症性心脏病。随访6个月后死亡的患者要么突然死亡，要么死于进行性心力衰竭。良好的预后常伴有滴度下降，但在有抗肌膜和抗肌膜抗体的患者中，这种下降不太明显。这些抗体高滴度持续存在在预后不良和心肌炎后扩张型心肌病患者中占主导地位，溶细胞血清活性也是如此。
