心肌炎的诊断与治疗现状

  • 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,近几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有更高的敏感性,心脏MRI日益受到重视:为心内膜活组织检查定位,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(ICD)起到稳定病情、渡过危重期的作用,IFN用于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。

     

    Abstract: The high mortality of myocarditis has attracted the clinical doctors’ eyes. The diagnosis and treatment of myocarditis has undergone the process from debating to consensus. The endomyocardial biopsy, combined with the technique of immunohistochemistry, has more sensitivity. The cardiovascular magnetic resonance is the hot topic, not only for that it can guide the endomyocardial biopsy, but also it has its own diagnosis criteria of myocarditis- Lake Louse consensus criteria. The cardiogenic shock and malignant ventricular arrhythmia should be intervened actively, by using the technique of extracorporeal membrane oxygenation and intra-aortic balloon pump and implantable cardioverter defibrillator(ICD). IFN is used to treat the patients with persistent virus infection, which can improve the prognosis of dilated cardiomyopathy and that intravenous immunoglobulin plays a role in the treatment of myocarditis of children. Lowing the mortality and the everlasting infectious rate of myocarditis is the future research point.

     

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