Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil.
Int J Cardiol. 2011 Apr 14;148(2):204-8. doi: 10.1016/j.ijcard.2009.11.002. Epub 2009 Nov 27.
There is scarce information on the potential benefits of immunosuppression in children with myocarditis and viral genomes in myocardium. We investigated the occurrence of myocarditis in children with a preliminary diagnosis of dilated cardiomyopathy, the frequency of cardiotropic viruses in the myocardium, and the response to immunosuppression.
Thirty patients (nine months to 12 years) with left ventricular ejection fraction of 22.8 ± 4.1% were subjected to right cardiac catheterization and endomyocardial biopsy. Specimens were analyzed for the presence of inflammatory elements (Dallas criteria) and viral genome (polymerase chain reaction). Patients with active myocarditis received immunosuppressants (azatioprine and prednisone) and were re-catheterized nine months later. A historical control group of nine patients with myocarditis who did not receive immunosuppressants was included.
Active myocarditis was diagnosed in ten patients (five with viral genomes detected). Immunosuppression resulted in a significant increase in left ventricular ejection fraction from 25.2 ± 2.8% to 45.7 ± 8.6% (versus 20.0 ± 4.0% to 22.0 ± 9.0% in historical controls, p<0.01) and cardiac index from 3.28 ± 0.51 L/min/m(2) to 4.40 ± 0.49 L/min/m(2) (versus 3.50 ± 0.40 L/min/m(2) to 3.70 ± 0.50 L/min/m(2) in controls, p<0.01), regardless of the presence of viral genomes (p=0.98 and p=0.22, respectively for the two variables). No relevant clinical events were observed. Non-inflammatory cardiomyopathy was diagnosed in 20 patients (seven with viral genomes). While on conventional therapy, there were four deaths and three assignments to transplantation, and no improvement of left ventricular ejection fraction in the remaining ones (22.5 ± 3.6% to 27.5 ± 10.6%).
Children with chronic myocarditis seem to benefit from immunosuppressive therapy, regardless of the presence of viral genome in the myocardium.
关于免疫抑制在心肌炎患儿中的潜在益处以及心肌中的病毒基因组，目前信息匮乏。我们研究了初步诊断为扩张型心肌病的患儿中心肌炎的发生情况、心肌中心病毒的频率以及免疫抑制的反应。
30 名患儿（9 个月至 12 岁）的左心室射血分数为 22.8 ± 4.1%，接受右心导管检查和心内膜心肌活检。分析标本中是否存在炎症元素（达拉斯标准）和病毒基因组（聚合酶链反应）。患有活动性心肌炎的患儿接受免疫抑制剂（硫唑嘌呤和泼尼松）治疗，并在 9 个月后再次进行导管插入术。还纳入了 9 名未接受免疫抑制剂治疗的心肌炎患儿的历史对照组。
10 名患儿（其中 5 名检测到病毒基因组）诊断为活动性心肌炎。免疫抑制治疗使左心室射血分数从 25.2 ± 2.8%显著增加至 45.7 ± 8.6%（与历史对照组的 20.0 ± 4.0%至 22.0 ± 9.0%相比，p<0.01）和心脏指数从 3.28 ± 0.51 L/min/m2 增加至 4.40 ± 0.49 L/min/m2（与对照组的 3.50 ± 0.40 L/min/m2 至 3.70 ± 0.50 L/min/m2 相比，p<0.01），无论是否存在病毒基因组（两个变量的 p 值分别为 0.98 和 0.22）。未观察到相关临床事件。20 名患儿诊断为非炎症性心肌病（其中 7 名存在病毒基因组）。在接受常规治疗时，有 4 例死亡和 3 例移植，其余患儿的左心室射血分数无改善（22.5 ± 3.6%至 27.5 ± 10.6%）。
慢性心肌炎患儿似乎受益于免疫抑制治疗，无论心肌中是否存在病毒基因组。
