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何武.慢性炎症性心肌病的诊疗现状：机遇与展望[J].内科急危重症杂志,2025,31(6):501-504
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| DOI：10.11768/nkjwzzzz20250603 |
| 中文关键词: 慢性炎症性心肌病 心肌炎 病理机制 诊断与治疗 免疫调节 |
| 英文关键词: |
| 基金项目:国家自然科学基金（82241034, 82330010, 824B2007）；国家重点研发计划（2024YFC3044500） |
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| 摘要点击次数: 7 |
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| 中文摘要: |
| 摘要 慢性炎症性心肌病(CI-CMP)是心肌炎迁延不愈进展所致的一类以持续性心肌炎症反应和心室重构为核心特征的慢性心血管疾病。其临床表现多样，既可以扩张型心肌病为表型出现，也可为非扩张性心功能障碍，常导致顽固性慢性心力衰竭及致命性心律失常。常见病因包括病毒感染、系统性自身免疫疾病及其他罕见炎症性或寄生虫性疾病，并受遗传易感性、免疫调节紊乱等多重因素共同驱动。心内膜心肌活检是确诊金标准，病理表现为心肌炎症细胞浸润及纤维化。标准抗心力衰竭药物治疗虽可部分缓解症状，但难以阻止疾病进展。近年来，基于病毒阴性炎症机制主导的患者，免疫抑制治疗（如泼尼松联合硫唑嘌呤）及新的免疫调节治疗（如羟氯喹联合泼尼松龙）在改善左室功能、降低不良结局方面显示出显著疗效，安全性亦较可控。但部分患者仍对免疫抑制无反应，提示遗传背景、病毒阴性感染及非经典免疫机制等需进一步研究。未来临床管理应重视患者个体化风险分层，开发灵敏的新型生物标志物和非侵入性诊断手段，探索多靶点精准免疫调节及联合治疗新策略。多中心、前瞻性随机对照试验和多组学数据的整合分析，有望为CI-CMP患者长期预后改善提供坚实依据。 |
| 英文摘要: |
| Abstract Chronic inflammatory cardiomyopathy is a type of chronic cardiovascular disease arising from persistent unresolved myocarditis, characterized by ongoing myocardial inflammatory response and ventricular remodeling. Its clinical manifestations are diverse, presenting as either a dilated cardiomyopathy phenotype or as non-dilated cardiac dysfunction, and frequently leading to refractory chronic heart failure and life-threatening arrhythmias. Common etiologies include viral infection, systemic autoimmune diseases, and other rare inflammatory or parasitic diseases, with pathogenesis driven by a combination of genetic susceptibility and immune dysregulation. Endomyocardial biopsy is the gold standard for diagnosis, demonstrating myocardial inflammatory cell infiltration and fibrosis pathologically. Although standard anti-heart failure pharmacotherapy may partially alleviate symptoms, it fails to halt disease progression. In recent years, for patients with virus-negative inflammation-driven mechanisms, immunosuppressive therapy (such as prednisone combined with azathioprine) and novel immunomodulatory treatments (such as hydroxychloroquine combined with prednisolone) have shown significant efficacy in improving left ventricular function and reducing adverse outcomes, with relatively controllable safety profiles. However, a subset of patients remains unresponsive to immunosuppression, indicating the need for further research into genetic backgrounds, virus-negative infections, and non-classical immune mechanisms. Future clinical management should emphasize individualized risk stratification, the development of sensitive novel biomarkers and non-invasive diagnostic approaches, and the exploration of multi-targeted, precise immunomodulatory and combination treatment strategies. Large-scale, prospective, randomized controlled trials and integrative multi-omics analyses are expected to provide solid evidence for improving the long-term prognosis in patients with chronic inflammatory cardiomyopathy. |
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