Maisch Bernhard
Faculty of Medicine, and Heart and Vessel Center, Philipps-University, Marburg, Germany.
Front Cardiovasc Med. 2019 Apr 12;6:48. doi: 10.3389/fcvm.2019.00048. eCollection 2019.
Myocarditis and inflammatory cardiomyopathy are syndromes, not aetiological disease entities. From animal models of cardiac inflammation we have detailed insight of the strain specific immune reactions based on the genetic background of the animal and the infectiosity of the virus. Innate and adaptive immunity also react in man. An aetiological diagnosis of a viral vs. a non-viral cause is possible by endomyocardial biopsy with histology, immunohistology and PCR for microbial agents. This review deals with the different etiologies of myocarditis and inflammatory cardiomyopathy on the basis of the genetic background and the predisposition for inflammation. It analyses the epidemiologic shift in cardiotropic viral agents in the last 30 years. Based on the understanding of the interaction between infection and the players of the innate and adaptive immune system it summarizes pathogenetic phases and clinical faces of myocarditis. It gives an up-to-date information on specific treatment options beyond symptomatic heart failure and antiarrhythmic therapy. Although inflammation can resolve spontaneously, specific treatment directed to the causative etiology is often required. For fulminant, acute, and chronic autoreactive myocarditis without viral persistence immunosuppressive treatment can be life-saving, for viral inflammatory cardiomyopathy ivIg treatment can resolve inflammation and often eradicate the virus.
心肌炎和炎症性心肌病是综合征，而非病因明确的疾病实体。从心脏炎症的动物模型中，我们基于动物的遗传背景和病毒的感染性，对菌株特异性免疫反应有了详细的了解。先天性免疫和适应性免疫在人类中也会产生反应。通过心内膜心肌活检，进行组织学、免疫组织学检查以及针对微生物病原体的聚合酶链反应（PCR），可以对病毒病因与非病毒病因做出诊断。本综述基于遗传背景和炎症易感性，探讨了心肌炎和炎症性心肌病的不同病因。分析了过去30年中嗜心性病毒病原体的流行病学变化。基于对感染与先天性和适应性免疫系统参与者之间相互作用的理解，总结了心肌炎的发病阶段和临床表象。提供了除症状性心力衰竭和抗心律失常治疗之外的特定治疗选择的最新信息。尽管炎症可自发消退，但通常仍需要针对病因进行特异性治疗。对于暴发性、急性和慢性自身反应性心肌炎且无病毒持续存在的情况，免疫抑制治疗可能挽救生命；对于病毒性炎症性心肌病，静脉注射免疫球蛋白（ivIg）治疗可消除炎症并常常根除病毒。
