Salvi A, Di Lenarda A, Dreas L, Silvestri F, Camerini F
Department of Cardiology, Ospedale Maggiore, Trieste, Italy.
Int J Cardiol. 1989 Mar;22(3):329-38. doi: 10.1016/0167-5273(89)90274-x.
Twenty patients (13 males and seven females) with a biopsy-proven diagnosis of myocarditis underwent a period of treatment with prednisone and azathioprine. The primary objective of the study was the observation of histologic changes which occur during treatment and after treatment withdrawal. The secondary objective was the detection, if any, of changes in left ventricular ejection fraction. Multiple endomyocardial biopsies were obtained and the treatment was adjusted in order to achieve complete disappearance of the myocardial inflammation. The histologic status was improved in all patients, although complete disappearance of the signs of active disease was seen in 15 patients only. Two patients died during the observation period. A clear relationship between histologic status and immunosuppression was established in some patients (50% of all cases showed a worsening after withdrawal from the treatment). An overall improvement of the ejection fraction was observed (from 0.37 +/- 0.14 to 0.46 +/- 0.17), but a direct effect of the treatment on the recovery of ventricular function cannot be stated. In some patients, however, a direct relationship between the histological changes and the changes in ejection fraction was seen. These data suggest that treatment with prednisone and azathioprine may be beneficial in some patients with biopsy-proven myocarditis and depressed ventricular function.
20例经活检证实为心肌炎的患者（13例男性，7例女性）接受了泼尼松和硫唑嘌呤的一段时间治疗。该研究的主要目的是观察治疗期间及停药后发生的组织学变化。次要目的是检测左心室射血分数的变化（如有）。获取了多次心内膜活检组织，并调整治疗方案以实现心肌炎症完全消失。所有患者的组织学状态均有改善，不过仅15例患者的活动性疾病体征完全消失。2例患者在观察期内死亡。部分患者（所有病例的50%）在停药后病情恶化，由此在组织学状态与免疫抑制之间建立了明确的关系。观察到射血分数总体有所改善（从0.37±0.14提高到0.46±0.17），但无法确定治疗对心室功能恢复有直接影响。然而，在部分患者中，观察到了组织学变化与射血分数变化之间的直接关系。这些数据表明，对于一些经活检证实为心肌炎且心室功能低下的患者，泼尼松和硫唑嘌呤治疗可能有益。
