Kühl U, Lauer B, Souvatzoglu M, Vosberg H, Schultheiss H P
Universitätsklinikum Benjamin Franklin, Abteilung Kardiologie, Berlin, Germany.
J Am Coll Cardiol. 1998 Nov;32(5):1371-6. doi: 10.1016/s0735-1097(98)00397-0.
This study compares the results of antimyosin scintigraphy in patients with clinically suspected myocarditis with histologic and immunohistologic findings in the endomyocardial biopsy.
In patients with clinically suspected myocarditis, antimyosin scintigraphy often demonstrates myocardial cell damage but histologic evaluation of the endomyocardial biopsy often fails to show evidence of myocarditis. Recently developed immunohistologic techniques appear to be more sensitive for the detection of myocardial inflammation than histologic analysis alone. Studies comparing antimyosin scintigraphy and immunohistologic analysis of the endomyocardial biopsy in patients with clinically suspected myocarditis are not yet available.
Sixty-five patients with clinically suspected myocarditis underwent antimyosin scintigraphy. Antimyosin antibody uptake was correlated with histologic and immunohistologic findings in the endomyocardial biopsy.
Antimyosin scintigraphy showed evidence of myocardial cell damage in 36 (55%) of the 65 patients and was negative in 29 (45%) patients. Histologic analysis of the endomyocardial biopsy revealed myocarditis in nine patients: six had a positive and three had a negative antimyosin scan, respectively. Thirty (83%) of 36 patients with evidence of myocardial cell damage on antimyosin scintigraphy were histologically negative for myocarditis. Immunohistologic analysis showed evidence of myocarditis in 31 (86%) of 36 patients with a positive antimyosin scan and also in 17 (59%) of 29 patients with a normal scan (p < 0.047).
Antimyosin scintigraphy often shows myocyte injury in patients with clinically suspected myocarditis. Histologic analysis of the endomyocardial biopsy alone is often negative, but additional immunohistologic analysis of the endomyocardial biopsy frequently provides evidence of myocardial inflammation in these patients. With immunohistologic analysis as the reference method, antimyosin scintigraphy has a high specificity but a lower sensitivity for the detection of myocarditis.
本研究比较临床疑似心肌炎患者抗肌凝蛋白闪烁扫描结果与心内膜心肌活检的组织学和免疫组织学检查结果。
在临床疑似心肌炎患者中，抗肌凝蛋白闪烁扫描常显示心肌细胞损伤，但心内膜心肌活检的组织学评估往往未能显示心肌炎证据。最近开发的免疫组织学技术似乎比单纯的组织学分析对心肌炎症检测更敏感。目前尚无比较临床疑似心肌炎患者抗肌凝蛋白闪烁扫描与心内膜心肌活检免疫组织学分析的研究。
65例临床疑似心肌炎患者接受抗肌凝蛋白闪烁扫描。抗肌凝蛋白抗体摄取与心内膜心肌活检的组织学和免疫组织学检查结果相关。
65例患者中，36例（55%）抗肌凝蛋白闪烁扫描显示心肌细胞损伤证据，29例（45%）为阴性。心内膜心肌活检的组织学分析显示9例患者患有心肌炎：其中6例抗肌凝蛋白扫描阳性，3例阴性。抗肌凝蛋白闪烁扫描显示有心肌细胞损伤证据的36例患者中，30例（83%）组织学检查心肌炎为阴性。免疫组织学分析显示，抗肌凝蛋白扫描阳性的36例患者中有31例（86%）以及扫描正常的29例患者中有17例（59%）存在心肌炎证据（p<0.047）。
抗肌凝蛋白闪烁扫描在临床疑似心肌炎患者中常显示心肌细胞损伤。单独的心内膜心肌活检组织学分析往往为阴性，但心内膜心肌活检的额外免疫组织学分析常常能为这些患者提供心肌炎症证据。以免疫组织学分析作为参考方法，抗肌凝蛋白闪烁扫描检测心肌炎具有高特异性但较低敏感性。
