免疫抑制及激素治疗巨细胞性心肌炎一例

Effects of Combined Immunosuppression With Corticosteroids Therapy for Giant Cell Myocarditis:a Case Report

巨细胞性心肌炎是一种罕见的疾病,其临床特点是发病后快速进展的心力衰竭,短期内可发展成难治性心力衰竭乃至心原性休克,需要紧急机械循环支持和心脏移植。本例34岁女性患者,上呼吸道感染后出现进行性左心室收缩功能显著降低,通过心内膜心肌活检确诊为巨细胞性心肌炎,给予免疫抑制联合激素治疗半年后,左心室收缩功能明显改善。对于感染后出现不确定的新发心肌病变伴心力衰竭,尤其是心力衰竭呈进行性加重时,应高度警惕巨细胞性心肌炎的可能性,快速及时的诊断对治疗和预后具有明确的临床意义。

Giant cell myocarditis is a rare disease.The clinical feature is rapid hemodynamic deterioration due to heart failure,which might develop into refractory heart failure or even cardiogenic shock necessitating urgent consideration of mechanical circulatory support and heart transplantation.We present a case of 34-year-old female with initial presentation of upper respiratory tract infection,and rapidly decline in left ventricular systolic function.Giant cell myocarditis was confirmed by endomyocardial biopsy.Combined immunosuppression and corticosteroids therapy was applied and left ventricular function improved significantly and the patient recovered half a year later.For new onset cardiomyopathy of uncertain etiology and heart failure,especially the rapid progression of heart failure after infection,the possibility of giant cell myocarditis should be highly vigilant,and timely diagnosis has distinct clinical implication on management and prognosis of these patients.