Petronio A S, Manes M T, Di Meco F, Nardini V, Pecori F, Ceccherini-Nellis L, Barsotti A, Mariani M
Istituto di Cardiologia, Università degli Studi, Pisa.
Cardiologia. 1993 Dec;38(12 Suppl 1):267-76.
This study was carried out on 43 patients affected by dilated cardiomyopathy to investigate some of the etiopathological hypotheses on this illness. The Authors investigated: the persistence of virus genoma (coxsackie, HBV) on endomyocardial biopsies; the pattern of the II class major histocompatibility complex (MHC) were in the blood lymphocytes; the microvascular aspect of coronary circulation in the endomyocardial biopsies. Finally, in a separated group of 19 patients, the microvascular circulation was studied on skin biopsies and correlated with diabetic, valvular and normal subject. The results showed a 14% positivity for the presence of the virus genoma and a significant predominate of DR5 in the II class MHC of patients with a worse ventricular function. Capillary vessels of the coronary microcirculation were dilated in the 48% of the patients, especially in more compromised subjects. Viral myocarditis seem to play a role in the etiopathogenesis of dilated cardiomyopathies (DCM) and the pattern of MHC could influence the progression of the illness. The microcirculation is probably a pathophysiological aspect. No etiological hypothesis seems to predominate.
本研究对43例扩张型心肌病患者进行，以探讨关于该疾病的一些病因病理假说。作者研究了：心内膜心肌活检中病毒基因组（柯萨奇病毒、乙肝病毒）的持续性；血液淋巴细胞中Ⅱ类主要组织相容性复合体（MHC）的模式；心内膜心肌活检中冠状动脉循环的微血管情况。最后，在一个由19名患者组成的单独队列中，研究了皮肤活检中的微循环，并与糖尿病患者、瓣膜病患者及正常受试者进行了对比。结果显示，病毒基因组阳性率为14%，且心室功能较差的患者Ⅱ类MHC中DR5显著占优势。48%的患者冠状动脉微循环的毛细血管扩张，尤其是在病情更严重的患者中。病毒性心肌炎似乎在扩张型心肌病（DCM）的病因发病机制中起作用，MHC模式可能影响疾病进展。微循环可能是一个病理生理方面的因素。似乎没有一种病因假说占主导地位。
