Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran AND Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Allergy Asthma Immunol. 2020 Aug 25;19(4):323-336. doi: 10.18502/ijaai.v19i4.4109.
Myocarditis is an inflammatory disease of the myocardium with lymphocyte infiltration and myocyte necrosis leading to a wide range of clinical presentations including heart failure, arrhythmia, and cardiogenic shock. Infectious and noninfectious agents may trigger the disease. The fact that immunosuppressive drugs are useful in several kinds of autoimmune myocarditis is proof of the autoimmune mechanisms involved in the development of myocarditis. Pathogenic mechanisms in myocardial inflammation are including inflammasome activation followed by myocyte destruction, myocarditis, and pericarditis. Intravenous immunoglobulin (IVIG) is a serum product made up of immunoglobulins, widely used in a variety of diseases. This product is effective in several immune-mediated pathologies. As well as the determined usage of IVIG in Kawasaki disease, IVIG may be useful in several kinds of heart failure including fulminant myocarditis, acute inflammatory cardiomyopathy, Giant Cell Myocarditis, and peripartum cardiomyopathy. Generally, IVIG is used in two different doses of low dose (200 to 400 mg/kg) and high dose (2 g/kg) regimen. The exact therapeutic effects of IVIG are not clear, however over the last decades, our knowledge about its mechanism of function has greatly enhanced. IVIG administration should be based on the accepted protocols of its transfusion. In this review article, we try to provide an overview of the different kinds of myocarditis, pathologic mechanisms and their common treatments and evaluation of the administration of IVIG in these diseases. Furthermore, we will review current protocols using IVIG in each disease individually.
心肌炎是一种心肌炎症性疾病，淋巴细胞浸润和心肌细胞坏死导致广泛的临床表现，包括心力衰竭、心律失常和心源性休克。感染和非感染性因素都可能引发这种疾病。免疫抑制剂在几种自身免疫性心肌炎中有效，这证明了自身免疫机制在心肌炎的发展中起作用。心肌炎症的发病机制包括炎症小体的激活，随后是心肌细胞的破坏、心肌炎和心包炎。静脉注射免疫球蛋白（IVIG）是一种由免疫球蛋白组成的血清产品，广泛应用于多种疾病。该产品对多种免疫介导的疾病有效。除了 IVIG 在川崎病中的明确用途外，IVIG 在包括暴发性心肌炎、急性炎症性心肌病、巨细胞心肌炎和围产期心肌病在内的几种心力衰竭中也可能有用。一般来说，IVIG 有两种不同的剂量使用，即低剂量（200 至 400mg/kg）和高剂量（2g/kg）方案。IVIG 的确切治疗效果尚不清楚，但在过去几十年中，我们对其作用机制的了解大大增强。IVIG 的给药应基于其输注的公认方案。在这篇综述文章中，我们试图概述不同类型的心肌炎、病理机制及其常见的治疗方法，并评估 IVIG 在这些疾病中的应用。此外，我们将逐个回顾每种疾病中 IVIG 的当前使用方案。
