心肌炎课件讲解.pptx

Myocarditis
天津医科大学总医院心血管病中心ecu 边波
2010. 1. 10
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Myocarditis Definition
■心肌炎(myocarditis):是指病原微生物感 染或非感染性炎症引起的以心肌细胞ry takes place, causing the release of antigenic intracellular components such as myosin into the bloodstream
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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
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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
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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 failure
■ Cardiomyopathy developed despite the absence of viral proliferation but was correlated with elevated levels of cytokines such as TNF
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Acute Myocarditis
Subacute Myocarditis
Chronic Myocarditis
4 days
14 days
0
Viremia
Viral clearing
Macrophage activation
Myocyte necrosis
Viral infection
90 days
Absence of virus
Infiltrating mononuclear cells
Cytokine Natural
expression -----1一► killer cells
• Interleukin 1
• lnterleukin<2 ▼.
• Tumor necrosis I Perforin
factor I ___* Nitric oxide
• lnterf0ron>
Cytotoxic T lymphocytes
B lymphocytes
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Fibrosis Cardiac dilatation Heart failure
Neutralizing antibodies
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VMC的临床分型
■临床从临床症状、病程和转归分为
□亚临床型心肌炎
口轻症自限型心肌炎
□隐匿进展型心肌炎
□急性重症型心肌炎
□猝死型心肌炎
■