Bowles N E, Towbin J A
Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
Curr Opin Cardiol. 1998 May;13(3):179-84.
The mechanisms of pathogenesis of myocarditis have remained elusive. Despite the demonstration a decade ago that persistent viral infection of the myocardium occurred in many patients, a clear description of the pathologic progression has not been forthcoming. Over the past year, a number of studies have added to the data defining the crucial roles of cytokine expression in the myocardium and the aberrant induction of apoptosis. Further, a mouse model of myocarditis resulting from the myocardial expression of tumor necrosis factor-alpha has been described. In addition, the identification of the common coxsackievirus B and adenovirus receptor has offered an explanation for the puzzling observation that these highly distinct virus types both cause cardiac disease. Finally, the near-eradication of endocardial fibroelastosis associated with persistent mumps virus infection by vaccination supports the notion that coxsackievirus B and adenovirus vaccines may help reduce the incidence of myocarditis.
心肌炎的发病机制一直难以捉摸。尽管十年前已证明许多患者的心肌存在持续性病毒感染，但尚未对病理进展进行清晰描述。在过去一年中，多项研究补充了相关数据，明确了细胞因子在心肌中的表达以及细胞凋亡异常诱导所起的关键作用。此外，还描述了一种由肿瘤坏死因子-α在心肌中表达导致的心肌炎小鼠模型。另外，常见的柯萨奇病毒B和腺病毒受体的鉴定，解释了这两种截然不同的病毒类型都会引发心脏疾病这一令人困惑的现象。最后，通过接种疫苗几乎根除了与持续性腮腺炎病毒感染相关的心内膜弹力纤维增生症，这支持了柯萨奇病毒B和腺病毒疫苗可能有助于降低心肌炎发病率的观点。
