心肌炎课件讲解.pptxVIP

Myocarditis;Myocarditis Definition;INTRODUCTION;INTRODUCTION ■ Studies suggest that myocarditis is a major cause of sudden (20%), unexpected death in adults less than 40 years of age ■ Prospective and retrospective studies have identified myocardial inflammation in 1 to 9 percent of routine postmortem examinations;CAUSES ■可分为慮函性和非慮染性两大类 ■ Viruses, bacteria, protozoa, and even worms have been implicated as infectious agents ■ A large variety of systemic diseases, drugs, and toxins have been associated with the development of this disease;心肌炎的总体特点 ■儿童和40岁以下成年人居多 ■男、女性别比例无差异 ■夏季多见(?)，冬季少见 ■临床表现多样化，无特异性症状体征 ■病毒难以找到，确诊困难 . VMC可引起急性心功能不全 ■ VMC可能慢性演变成扩张性心肌病;病毒性心肌炎的病因;VMC的发病机制;Pathophysiology;Phase I: Viral Infection and Replication ■ Coxsackievirus B3 causes an infectious phase, which lasts 7-10 days, and is characterized by active viral replication ■ During this phase initial myocyte injury takes place, causing the release of antigenic intracellular components such as myosin into the bloodstream;Phase 2: Autoimmunity and injury ■ The local release of cytokines, such as interleukin-l, interleukin-2, interleukin-6, tumor necrosis factor (TNF), and nitric oxide may play a role in determining the T-cell reaction and the subsequent degree of autoimmune perpetuation ■ These cytokines may also cause reversible depression of myocardial contractility without causing cell death;Phase 2: Autoimmunity and injury ■ Immune-mediated by CD8 lymphocytes and autoantibodies against various myocyte components ■ Antigenic mimicry, the cross reactivity of antibodies to both virus and myocardial proteins ■ Myocyte injury may be a direct result of CD8 lymphocyte infiltration;Phase 3： Dilated Cardiomyopathy ■ Viruses may also directly cause myocyte apoptosis. ■ During the autoimmune phase, cytokine activate the matrix metalloproteinases, such as gelatinase, collagenases, and elastases ■ In later stages of immune activation, cytokines play a leading role in adverse remodeling and progressive heart