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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 further explore the relationship between coxsackievirus (CVB) infection and myocarditis and dilated cardiomyopathy (DCM), and to find a rapid, sensitive and specific auxiliary examination method for the clinical diagnosis of viral myocarditis. Methods 27 cases of myocardial biopsy tissues were examined by nested-reverse transcription polymerase chain reaction (nRT-PCR). 9 cases of normal and 1 case of myocardial infarction were used as controls. Meanwhile, indirect immunofluorescence assay was used to detect the expression of CVB RNA in 10 cases Patients with serum CVB1 ~ 6IgM. Results The positive rate of CVB RNA was detected in 5 cases of myocarditis in 14 cases of myocarditis and in 13 cases of DCM respectively. The positive rates of CVB RNA were 35.7% and 38.5% respectively, but not in the control group (P <0.05). The CVB RNA was negative in 4 CVBIgM1-6 positive and 4 CVB RNA positive in 6 CVB1-6 IgM negative myocardium. Conclusion Some DCM may be caused by CVB persistent infection after viral myocarditis. NRT-PCR is sensitive and specific, which is very suitable for rapid clinical diagnosis of viral myocarditis.