心肌病患者心肌中相关病毒的测定

Detection of Viruses in the Myocardium of Patients with Cardiomyopathy

目的:探讨炎症性心肌病、扩张型心肌病(idiopathicdilatedcardiomyopathy,IDCM)、肥厚型心肌病(hypertrophiccardiomy—opathy,HCM)与心肌中细小病毒B19(parvovirusB19,PB19)、腺病毒和肠病毒的关系。方法:利用多聚酶链反应(PCR),比较30例炎症性心肌病、36例IDCM、13例HCM及36例对照组患者心内膜活检标本中PB19、腺病毒及肠病毒的检出率,并用荧光素探针实时定量PCR检测PB19拷贝数。结果:30例炎症性心肌病患者中有4例PB19阳性(13.3%)、1例腺病毒阳性(3.3%)、10例肠病毒阳性(33.3%);36例IDCM中有3例PB19阳性(8.3%)、1例腺病毒阳性(2.8%)、7例肠病毒阳性(19.4%);13例HCM中有2例PB19阳性(15.4%)、1例肠病毒阳性(7.69%)、腺病毒阴性。而对照组未检出病毒序列。PB19量从70拷贝/μg至3900拷贝/μg,炎症性心肌病PB19DNA拷贝数高于IDCM组和HCM组。结论:PB19和肠病毒一样是炎症性心肌病、IDCM病因之一,可能与HCM发生也有一定关系,而腺病毒为非主要致病病毒;炎症性心肌病的高拷贝PB19DNA提示病毒感染是诱发心肌炎症反应的机制之一。

Objective: To analyze parvovirus B19 (PB19)., adenovirus., and enterovirus genome on myocardium from patients with inflammatory cardiomyopathy, idiopathic dilated cardiomyopathy (IDCM) and hypertrophic cardiomyopathy (HCM). Methods: Specimens were obtained from patients with inflammatory cardiomyopathy (30) ,IDCM (36) and HCM (13). Controls were collected from 36 subjects without history of myocarditis, IDCM or recent infection. All myocardial specimens were screened for viral genome by PCR analysis. The myocardial specimens underwent quantitative screening for the PB19 viral genome via real-time PCR analysis. Results: Adenovirus was amplified from 1 of 30 inflammatory cardiomyopathy cases (3. 3%) and 1 of 36 IDCM cases (2. 8%), but not amplified in HCM case; Enterovirus was amplified from 10 of 30 inflammatory cardiomyopathy cases (33. 3%), 7 of 36 IDCM cases (19. 4%) and 1 of 13 HCM cases (7. 69%); PB19 was amplified from 4 of 30 inflammatory cardiomyopathy cases (13. 3%), 3 of 36 IDCM cases (8. 3%) and 2 of 13 HCM cases (15. 4%). Cbntrol samples were negative for all viruses tested. The copy numbers for PB19 DNA ranged between 70 and 3900 copies per μg of DNA and were the highest in patients with inflammatory cardiomyopathy. Conclusion; This data suggested that infection by enterovirus and parvovirus B19 are commonly associated with IDCM or inflammatory cardiomyopathy in adult patients, may be also with HCM, where adenoviruses are not major pathogens of inflammatory cardiomyopathy or IDCM High copy numbers for PB19 in inflammatory cardiomyopathy appear to be a triggering mechanism for an inflammatory reaction in the myocardium.