心肌炎的诊断与治疗现状.pdf

新医学2011年2月第42卷第2期71

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心肌炎的诊断与治疗现状

董瑞庆杨俊华

[摘要]暴发性心肌炎的高猝死率再次将心肌炎引入临床医生的视线，近年来心肌炎的诊断

与治疗从争议中逐渐趋于共识。与免疫组织化学方法相结合的心内膜心肌活组织检查(活检)

有更高的敏感性，心脏MR1日益受到重视，它能为心内膜活检定位，此外，心脏MRI的Lake

Louise共识标准已开始推广。心源性休克及恶性心律失常应积极干预，体外膜肺氧合、主动脉内

球囊反搏及埋藏式心脏转复除颤器起到稳定病情、渡过危重期的作用，IFN用于治疗持续合并病

毒感染者，改善扩张型心肌病的预后，静脉滴注丙种球蛋白在小儿心肌炎治疗中有一定地位。降

低暴发性心肌炎猝死率及慢性心肌炎病毒持续感染率是日后探索的重要方向。

[关键词]心肌炎；心内膜心肌活组织检查；心脏磁共振成像；诊断与治疗

ThecurrentdiagnosisandtreatmentofmyocarditisDONGRui—qing，YANGJun—hua．DepartmentofCardiol—

ogy，TheFirstAffiliatedHospitalofSoochowUniversity，Suzhou215006，China

[Abstract]Thehighmortalityofmyocarditishasattractedtheclinicaldoctors’eyes，Thediagnosisandtreat—

mentofmyocarditishasundergonetheprocessfromdebatingtoconsensus．Theendomyocardialbiopsy，combined

withthetechniqueofimmunohistochemistry，hashighersensitivity．Thecardiovascularmagneticresonanceisthe

hottopic，notonlycanitguidetheendomyocardialbiopsy，italsohasitsowndiagnosiscriteriaofmyocarditis—

LakeLouseconsensuscriteria．Thecardiogenicshockandmalignantventriculararrhythmiashouldbeintervened

actively，byusingthetechniqueofextracorporealmembraneoxygenation，intra—aorticballoonpumpandimplant·

．

ablecardioverterdefibrillator．IFNisusedtotreatthepatientswithpersistentvirusinfection，whichcanimprove

theprognosisofdilatedcardiomyopathy．Andintravenousimmunoglobulinplaysaroleinthetreatmentofmyocardi—

tisofchildren．Lowingthemortalityandtheeverlastinginfectiousrateofmyocarditisarethedirectionsoffuturere-

search．

[Keywords]Myocarditis；Endomyocardialbiopsy；Cardiovascularmagneticresonance；Diagnosisandtreat—

ment

1引言上，对目前心肌炎的诊断