Schowengerdt K O, Ni J, Denfield S W, Gajarski R J, Bowles N E, Rosenthal G, Kearney D L, Price J K, Rogers B B, Schauer G M, Chinnock R E, Towbin J A
Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston 77030, USA.
Circulation. 1997 Nov 18;96(10):3549-54. doi: 10.1161/01.cir.96.10.3549.
Inflammatory diseases of the heart, including myocarditis and cardiac transplant rejection, are important causes of morbidity and mortality in children. Although viral infection may be suspected in either of these clinical conditions, the definitive etiology is often difficult to ascertain. Furthermore, the histology is identical for both disorders. Coxsackievirus has long been considered the most common cause of viral myocarditis; however, we previously demonstrated by polymerase chain reaction (PCR) analysis that many different, and sometimes unexpected, viruses may be responsible for myocarditis and cardiac rejection. In this study, we describe the association of parvovirus genome identified through PCR analysis of cardiac tissue in the clinical setting of myocarditis and cardiac allograft rejection.
Myocardial tissue from endomyocardial biopsy, explant, or autopsy was analyzed for parvovirus B19 using primers designed to amplify a 699-base pair PCR product from the VP1 gene region. Samples tested included those obtained from patients with suspected myocarditis (n=360) or transplant rejection (n=200) or control subjects (n=250). Parvoviral genome was identified through PCR in 9 patients (3 myocarditis; 6 transplant) and no control patients. Of the 3 patients with myocarditis, 1 presented with cardiac arrest leading to death, 1 developed dilated cardiomyopathy, and the other gradually improved. Four of the 6 transplant patients had evidence of significant rejection on the basis of endomyocardial biopsy histology. All transplant patients survived the infection.
Parvovirus is associated with myocarditis in a small percentage of children and may be a potential contributor to cardiac transplant rejection. PCR may provide a rapid and sensitive method of diagnosis.
心脏炎性疾病，包括心肌炎和心脏移植排斥反应，是儿童发病和死亡的重要原因。尽管在这两种临床情况下都可能怀疑是病毒感染，但确切病因往往难以确定。此外，这两种疾病的组织学表现相同。柯萨奇病毒长期以来一直被认为是病毒性心肌炎最常见的病因；然而，我们之前通过聚合酶链反应（PCR）分析证明，许多不同的、有时甚至是意想不到的病毒可能导致心肌炎和心脏排斥反应。在本研究中，我们描述了在心肌炎和心脏同种异体移植排斥反应的临床背景下，通过对心脏组织进行PCR分析鉴定出的细小病毒基因组之间的关联。
使用设计用于从VP1基因区域扩增699个碱基对PCR产物的引物，对心内膜心肌活检、心脏移植或尸检获得的心肌组织进行细小病毒B19分析。测试样本包括从疑似心肌炎患者（n = 360）、移植排斥患者（n = 200）或对照受试者（n = 250）获得的样本。通过PCR在9例患者（3例心肌炎；6例移植）中鉴定出细小病毒基因组，而对照患者中未鉴定出。在3例心肌炎患者中，1例出现心脏骤停导致死亡，1例发展为扩张型心肌病，另1例逐渐好转。6例移植患者中有4例根据心内膜心肌活检组织学有明显排斥反应的证据。所有移植患者在感染后均存活。
细小病毒在一小部分儿童中与心肌炎有关，可能是心脏移植排斥反应的潜在原因。PCR可能提供一种快速、灵敏的诊断方法。
