Blagova Olga, Rud' Ruslan, Kogan Evgeniya, Zaitsev Alexander, Nedostup Alexander
Department of Faculty Therapy No.1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 6, B. Pirogovskaya St., 119992 Moscow, Russia.
Department of Pathology, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119992 Moscow, Russia.
J Clin Med. 2023 Jul 26;12(15):4913. doi: 10.3390/jcm12154913.
This paper aimed to study the efficacy and safety of mycophenolate mofetil (MM) in combination with corticosteroids in the treatment of lymphocytic myocarditis (LM) when compared to the standard combination of corticosteroids and azathioprine.
The study included 50 adult patients (47.8 ± 10.8 y.o.) in a NYHA III functional class due to LM who were verified using endomyocardial biopsy. The main group included 29 patients who received MM at 2 g/day. The comparison group comprised 21 patients who received azathioprine at 150 [50; 150] mg/day. Both groups were administered with methylprednisolone. The average follow-up period was 30 [22; 35] months, but no less than 6 months.
The groups were comparable in the baseline parameters and standard drug therapy. In both groups, there was a comparable significant increase in the ejection fraction (from 30.6 ± 7.7% to 44.0 ± 9.4% vs. 29.2 ± 7.7% to 46.2 ± 11.8%, < 0.001), and a decrease in systolic pressure in the pulmonary artery and the dimensions of the left ventricle and atrium. The frequency of death was two (6.9%) and two (9.5%), transplantation was one (3.4%) and one (4.8%) patient and the "death + transplantation" endpoint was three (10.3%) and three (14.3%) without differences between the groups. The presence of the parvovirus B19 in the myocardium in 6/5 patients did not affect the results. The incidence of infectious complications was comparable. The most severe infectious complications were pneumonia and fatal purulent encephalitis (both cases in the azathioprine group), leptospirosis meningitis (in the mycophenolate mofetil group).
In the patients with LM, the combination of corticosteroids with MM at a dose of 2 g/day was at least no less effective than with azathioprine. There was a tendency toward a better tolerance using MM.
本文旨在研究与皮质类固醇和硫唑嘌呤的标准联合用药相比，霉酚酸酯（MM）联合皮质类固醇治疗淋巴细胞性心肌炎（LM）的疗效和安全性。
该研究纳入了50例因LM导致纽约心脏协会（NYHA）心功能Ⅲ级的成年患者（年龄47.8±10.8岁），通过心内膜心肌活检进行确诊。主要组包括29例接受2g/天MM治疗的患者。对照组包括21例接受150[50;150]mg/天硫唑嘌呤治疗的患者。两组均给予甲泼尼龙。平均随访期为30[22;35]个月，但不少于6个月。
两组在基线参数和标准药物治疗方面具有可比性。两组的射血分数均有显著可比的增加（从30.6±7.7%增至44.0±9.4%，对比从29.2±7.7%增至46.2±11.8%，<0.001），肺动脉收缩压以及左心室和左心房尺寸减小。死亡频率分别为2例（6.9%）和2例（
