心肌组织柯萨奇病毒-腺病毒受体表达与病毒持续感染的关系

Expression of Coxsackie-adenovirus receptor and viral persistent infection

目的探讨心肌组织中柯萨奇病毒-腺病毒受体(CAR)表达与病毒性心肌病发病的关系。方法应用免疫组化技术检测慢性心肌炎和扩张型心肌病(DCM)心肌组织中CAR的表达;应用巢式聚合酶链反应检测相应心肌组织中柯萨奇B组病毒(CVB)RNA和腺病毒(AV)DNA,并以冠心病和先心病等非感染性心脏疾病心肌组织及意外事故死亡者正常心肌标本为对照组。结果26例心肌炎和39例DCM心肌组织中均检测到较高水平CAR表达(0.011 6±0.003 6),而对照组仅有较低表达(0.004 0±0.0025),两组比较差异有非常显著意义(P< 0.001)。心肌炎和DCM患者心肌中CVB RNA 阳性率分别为42%和35.9%(平均38.5%),AV DNA阳性率分别为15.4%和10.3%(平均12.3%),对照组14例均为阴性。心肌组织病毒核酸阳性者CAR免疫组化面积积分(0.013 1±0.003 4)较阴性者(0.010 1±0.003 0)明显增高(P< 0.001)。结论CAR在慢性心肌炎和DCM心肌组织中表达明显增高,心肌组织中CVB和AV感染与CAR表达上调相关,在慢性心肌炎和DCM的发病过程中可能起重要作用。

Objective To determine the connection between the expression of Coxsackie-adenovirus receptor(CAR) in human myocardium and the pathogenesis of viral heart disease. Methods The immuno-histochemistry was applied in examining the expression of CAR in myocardium of dilated cardiomyopathy(DCM) and chronic myocarditis. And the nested polymerase chain reaction was also applied in detecting Coxsackievirus B(CVB) RNA and adenovirus(AV) DNA in relevant heart tissues, while seven samples taken from patients with non-infectious heart diseases such as coronary heart disease and congenital heart disease, and 7 normal hearts of death by misadventure were used as controls. Results Strong CAR immunoreactivity signals were observed in myocardium in almost all of the myocarditis(26 cases)and DCM(39 cases)patients in various grades(0.011 6±0.003 6), in comparison with the above, the area fraction of normal and non-infectious heart diseases was very low (0.004 0±0.002 5,P < 0.001). CVB and AV gene segment were detected in average at 38.5% and 12.3% patients respectively with chronic myocarditis or DCM, while samples from control subjects systematically yielded negative results. The abundance of CAR expression in tissues positive for viral genome was obviously higher(0.013 1±0.003 4)than the negative ones(0.010 1±0.003 0,P < 0.001). Conclusions The level of CAR expression is markedly higher in chronic myocarditis and DCM. The re-expression of CAR in myocardium may facilitate the predisposition for CAR-dependent virus infection, and may play an important role in the pathogenesis of chronic myocarditis or DCM.