Maisch B, Pankuweit S
Department of Internal Medicine and Cardiology, University Hospital Gießen & Marburg, 35043, Marburg, Germany.
Herz. 2012 Sep;37(6):644-56. doi: 10.1007/s00059-012-3679-9.
In inflammatory dilated cardiomyopathy and myocarditis there is--apart from heart failure and antiarrhythmic therapies--no alternative to an aetiologically driven specific treatment. Prerequisite are noninvasive and invasive biomarkers including endomyocardial biopsy and PCR on cardiotropic agents. This review deals with the different etiologies of myocarditis and inflammatory cardiomyopathy including the genetic background, the predisposition for heart failure and inflammation. It analyses the epidemiologic shift in pathogenetic agents in the last 20 years, the role of innate and aquired immunity including the T- and B-cell driven immune responses. The phases and clinical faces of myocarditis are summarized. Up-to-date information on current treatment options starting with heart failure and antiarrhythmic therapy are provided. Although inflammation can resolve spontaneously, specific treatment directed to the causative aetiology is often required. For fulminant, acute and chronic autoreactive myocarditis immunosuppressive treatment is beneficial, while for viral cardiomyopathy and myocarditis ivIg can resolve inflammation and is as successful as interferon therapy in enteroviral and adenoviral myocarditis. For Parvo B19 and HHV6 myocarditis eradication of the virus is still a problem by any of these treatment options. Finally, the potential of stem cell therapy has to be tested in future trials. In virus-negative, autoreactive perimyocardial disease a locoregional approach with intrapericardial instillation of high local doses of triamcinolone acetate has been shown to be highly efficient and with few systemic side-effects.
在炎症性扩张型心肌病和心肌炎中，除了心力衰竭和抗心律失常治疗外，没有其他针对病因的特异性治疗方法。前提条件是非侵入性和侵入性生物标志物，包括心内膜心肌活检和针对嗜心肌病原体的聚合酶链反应。本综述探讨了心肌炎和炎症性心肌病的不同病因，包括遗传背景、心力衰竭和炎症的易感性。分析了过去20年中致病因子的流行病学变化、固有免疫和获得性免疫的作用，包括T细胞和B细胞驱动的免疫反应。总结了心肌炎的阶段和临床表象。提供了从心力衰竭和抗心律失常治疗开始的当前治疗选择的最新信息。虽然炎症可以自发消退，但通常需要针对病因的特异性治疗。对于暴发性、急性和慢性自身反应性心肌炎，免疫抑制治疗是有益的，而对于病毒性心肌病和心肌炎，静脉注射免疫球蛋白可以消退炎症，在肠道病毒和腺病毒心肌炎中与干扰素治疗效果相当。对于细小病毒B19和人疱疹病毒6型心肌炎，这些治疗方法中的任何一种都难以解决病毒清除问题。最后，干细胞治疗的潜力有待未来试验验证。在病毒阴性的自身反应性心肌周围疾病中，心包内高剂量局部注射醋酸曲安奈德的局部治疗方法已被证明高效且全身副作用少。
