nRT-PCR法检测心肌活检组织中柯萨奇B组病毒RNA的临床意义

Search for Coxsackie B virus RNA in endomyocardial biopsy tissues using nRT-PCR

目的进一步探讨柯萨奇病毒（ＣＶＢ）感染与心肌炎及扩张型心肌病（ＤＣＭ）发病的关系，同时为临床诊断病毒性心肌疾病探求一个快速、敏感和特异的辅助检查方法。方法应用巢式逆转录聚合酶链反应（ｎＲＴ－ＰＣＲ）检测 ２７例心肌活检组织中 ＣＶＢ ＲＮＡ，并以 ９例正常及 １例先心病心肌标本为对照；同时应用间接免疫荧光法检测其中 １０例患者血清 ＣＶＢ１～６ＩｇＭ。结果 １４例心肌炎及 １３例 ＤＣＭ患者中各有５例心肌组织中检测到 ＣＶＢ ＲＮＡ，阳性率分别为３５．７％和３８．５％，而对照组无一阳性（Ｐ＜０．０５）。４例血清ＣＶＢＩｇＭ１～６阳性者，心肌中ＣＶＢ ＲＮＡ均为阴性，而 ６例 ＣＶＢ１～６ ＩｇＭ阴性者中有 ４例心肌组织 ＣＶＢ ＲＮＡ阳性。 结论一部分 ＤＣＭ可能是由病毒性心肌炎后ＣＶＢ持续性感染所致，ｎＲＴ－ＰＣＲ法敏感、特异，非常适合病毒性心肌疾病的临床快速诊断。

Objective To study the relationship in the pathogenesis between the Coxsackie virus B(CVB) infection and myocarditis, or and dilated cardiomyopathy(DCM), and explore a rapid , specific and sensitive technique for clinical diagnosis. Methods Twenty-seven endomyocardial biopsy(EMB) specimens obtained from patients with myocarditis or DCM were tested for the presence of CVB RNA, using nested reverse transcriptase polymerize chain reaction(nRT-PCR). Nine myocardial samples from normal individuals, and 1 case from congenital heart disease were used as controls. Meanwhile 10 of the 27 patients were examined for CVB1-6, IgM in serum by indirect immunofluorescent technique. Results CVB RNA was detected in 5 EMB specimens of 14 patients(35 .7%) with post-myocarditis based upon the pathological examination , and the same for 13 cases with DCM(38. 5%). But none of the controls was positive for CVB RNA(P < 0. 05). However 4 patients which had CVB IgM in blood were negative for CVB RNA in myocardium. Whereas 6 cases which were negative for CVB IgM in serum,4 out of them had CVB RNA in myocardium. Conclusion A proportion of DCM are possibly due to persistent viral infection of CVB following an episode of viral myocarditis. nRT-PCR is a very specific and sensitive technique for the diagnosis of viral myocardial disease.