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目的探讨扩张型心肌病(DCM)的各致病因素,分析病毒在DCM发病中的作用。方法采用逆转录聚合酶链式反应(RT-PCR)检测患者血肠病毒RNA(Evs-RNA)、柯萨奇病毒(Cox-B)和巨细胞病毒(CMV)。对患者病史、诊治过程、随访结果进行回顾性分析。结果病毒阳性185例,占总人数的61.46%,其中Evs-RNA阳性119例,Cox-B阳性96例,CMV阳性53例。经过平均2.1年随访,平均左室舒张期末内径(LVEDd)62.2±8.4mm,平均左室射血分数(LVEF)43.69±11.53%,平均心胸比(CRT)0.57±0.09;与治疗前比较具有显著差异(P<0.05),NYHA心功能分级均改善Ⅰ～Ⅱ级。结论发病前病毒感染史是DCM主要的致病因素。早期针对病毒感染的免疫学治疗能够显著改善患者的心肌功能,提高其生活质量。应将病毒学检查作为扩张型心肌病的常规检查项目。
Objective To investigate the risk factors of dilated cardiomyopathy (DCM) and analyze the role of the virus in the pathogenesis of DCM. Methods Evans-RNA, Cox-B and cytomegalovirus (CMV) were detected by reverse transcriptase polymerase chain reaction (RT-PCR). The patient’s medical history, diagnosis and treatment process, follow-up results were retrospectively analyzed. Results 185 were positive for the virus, accounting for 61.46% of the total, of which 119 were Evs-RNA positive, 96 were Cox-B positive and 53 were CMV positive. After an average of 2.1 years of follow-up, mean left ventricular end-diastolic diameter (LVEDd) was 62.2 ± 8.4mm, mean left ventricular ejection fraction (LVEF) was 43.69 ± 11.53% and mean cardiothoracic ratio (CRT) was 0.57 ± 0.09, (P <0.05), NYHA functional class improved grade Ⅰ ~ Ⅱ. Conclusion The incidence of viral infection before onset is the main cause of DCM. Early immunological treatment of viral infections can significantly improve patients’ myocardial function and improve their quality of life. Virological examination should be used as a routine examination of dilated cardiomyopathy.