Lee H R, O'Connell J B, Mason J W
Division of Cardiology, University of Utah School of Medicine, Salt Lake City.
Cardiol Clin. 1989 Feb;7(1):171-81.
Two potential treatments, immunosuppression for myocarditis and beta-adrenergic blockade for heart failure, have been advocated. However, definitive conclusions await the result of ongoing large, multicenter, randomized clinical trials. There is circumstantial evidence that myocarditis may be a common precursor of dilated cardiomyopathy. Animal studies of myocarditis suggest that critically timed immunosuppression may be an effective therapy. Although promising, clinical studies to date are small and mostly uncontrolled. Clinical studies have demonstrated that beta-blockers are generally well tolerated in heart failure, and long-term treatment may result in improved symptomatic and functional status. These effects may be due to antagonism of direct and indirect effects of chronic reflex sympathetic stimulation on the cardiovascular system, including down-regulation of the myocardial beta-adrenergic receptor. However, prolongation of survival has not been documented by any studies. Initiation of beta-blockade requires careful patient selection and titration with small initial doses of metoprolol.
已经有人提出了两种潜在的治疗方法，即针对心肌炎的免疫抑制治疗和针对心力衰竭的β-肾上腺素能阻滞剂治疗。然而，确切的结论还有待正在进行的大型多中心随机临床试验的结果。有间接证据表明心肌炎可能是扩张型心肌病的常见前驱疾病。心肌炎的动物研究表明，在关键时间进行免疫抑制可能是一种有效的治疗方法。尽管前景乐观，但迄今为止的临床研究规模较小且大多未设对照。临床研究表明，β受体阻滞剂在心力衰竭患者中通常耐受性良好，长期治疗可能会改善症状和功能状态。这些作用可能是由于慢性反射性交感神经刺激对心血管系统的直接和间接作用的拮抗作用，包括心肌β-肾上腺素能受体的下调。然而，尚无任何研究证明其能延长生存期。开始使用β受体阻滞剂需要仔细选择患者，并从小剂量美托洛尔开始滴定给药。
