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一例经免疫抑制和中心体外膜肺氧合治疗缓解的慢性心肌炎病例。

A case of chronic myocarditis remitted by immunosuppressive and central extracorporeal membrane oxygenation therapy.

作者信息

Nakamura Makiko, Imamura Teruhiko, Hida Yuki, Oshima Akira, Yokoyama Shigeki, Doi Toshio, Fukahara Kazuaki, Kinugawa Koichiro

机构信息

The Second Department of Internal Medicine, University of Toyama, Toyama, Japan.

Department of Cardiovascular Surgery, University of Toyama, Toyama, Japan.

出版信息

J Cardiol Cases. 2021 Dec 30;25(6):330-334. doi: 10.1016/j.jccase.2021.12.005. eCollection 2022 Jun.

Abstract

The concept and therapeutic strategy for chronic lymphocytic myocarditis remain unestablished. We had a 57-year-old man with advanced biventricular (predominantly right ventricular) failure due to chronic lymphocytic myocarditis. He received central extracorporeal membrane oxygenation therapy that was explanted on day 129 following the aggressive steroid pulse and plasma exchange therapy. Infiltration of inflammatory cells persisted even after the device removal, which required long-term oral steroid administration after the index discharge on day 200. High-sensitivity cardiac troponin T level was normalized and inflammatory cell infiltration was remitted following post-discharge 4-month 10 mg/day prednisolone therapy. Aggressive immunosuppressive therapy under mechanical circulatory support might be a promising strategy for those with chronic lymphocytic myocarditis. < "Chronic myocarditis" does not exist as a formal classification of myocarditis worldwide and therapeutic strategy remains controversial. Aggressive immunosuppressive therapy under mechanical circulatory support might be a promising strategy for chronic lymphocytic myocarditis.>.

摘要

慢性淋巴细胞性心肌炎的概念和治疗策略尚未确立。我们有一名57岁男性,因慢性淋巴细胞性心肌炎出现晚期双心室(主要是右心室)衰竭。他接受了中心体外膜肺氧合治疗,在积极的类固醇冲击和血浆置换治疗后的第129天撤机。即使在设备移除后,炎症细胞浸润仍持续存在,这需要在第200天出院后长期口服类固醇。出院后接受4个月每天10毫克泼尼松龙治疗后,高敏心肌肌钙蛋白T水平恢复正常,炎症细胞浸润缓解。对于慢性淋巴细胞性心肌炎患者,在机械循环支持下进行积极的免疫抑制治疗可能是一种有前景的策略。<“慢性心肌炎”在全球范围内并非心肌炎的正式分类,治疗策略仍存在争议。在机械循环支持下进行积极的免疫抑制治疗可能是慢性淋巴细胞性心肌炎的一种有前景的策略。>

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