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中华诊断学电子杂志 ›› 2022, Vol. 10 ›› Issue (04) : 238 -242. doi: 10.3877/cma.j.issn.2095-655X.2022.04.005

心血管疾病诊治

病毒性心肌炎向扩张型心肌病转变进展的诊断学特征
于晓倩1, 徐瑞1,(), 黄文2, 吴霞1, 赵学强1, 郑飞1, 李欣然1   
  1. 1. 250014 济南,山东大学附属千佛山医院 山东第一医科大学第一附属医院(山东省千佛山医院)心内科
    2. 250014 济南,山东大学附属千佛山医院 山东第一医科大学第一附属医院(山东省千佛山医院)超声医学科
  • 收稿日期:2022-04-18 出版日期:2022-11-25
  • 通信作者: 徐瑞
  • 基金资助:
    山东省自然科学基金(ZR2019PH057)

Clinical diagnostic features of viral myocarditis to dilated cardiomyopathy

Xiaoqian Yu1, Rui Xu1,(), Wen Huang2, Xia Wu1, Xueqiang Zhao1, Fei Zheng1, Xinran Li1   

  1. 1. Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan 250014, China
    2. Department of Medical Ultrasound, Shandong Provincial Qianfoshan Hospital, Shandong University, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan 250014, China
  • Received:2022-04-18 Published:2022-11-25
  • Corresponding author: Rui Xu
引用本文:

于晓倩, 徐瑞, 黄文, 吴霞, 赵学强, 郑飞, 李欣然. 病毒性心肌炎向扩张型心肌病转变进展的诊断学特征[J]. 中华诊断学电子杂志, 2022, 10(04): 238-242.

Xiaoqian Yu, Rui Xu, Wen Huang, Xia Wu, Xueqiang Zhao, Fei Zheng, Xinran Li. Clinical diagnostic features of viral myocarditis to dilated cardiomyopathy[J]. Chinese Journal of Diagnostics(Electronic Edition), 2022, 10(04): 238-242.

目的

探讨病毒性心肌炎向扩张型心肌病转变进展的临床诊断学特征。

方法

回顾性分析2021年9月3日山东省千佛山医院心内科收治的1例由病毒性心肌炎向扩张型心肌病转变患者9年来的临床资料。

结果

患者自2012年3月,9年来5次因感冒后出现胸闷、心悸,服用药物控制不佳入院。9年来患者左室射血分数及室间隔厚度随时间显著上下波动,自2018年持续降低。2017年6月心脏MRI显示心室壁广泛变薄,左室舒张末期最大径60.15 mm。基因检测报告提示患者有扩张型心肌病,桥粒斑蛋白(DSP)基因C.2794-2 A>G位点突变,与临床表型相关。患者9年来规律服药且尽量规避疾病相关诱因,心脏的生理结构仍然出现了难以逆转的改变。

结论

对于携带有致病基因的扩张型心肌病患者,其发生相关疾病的可能性更大,产生的损害更为严重。因此,推进个体化精准治疗,早期发现相关致病基因,对于早期发现病因、控制疾病进展具有非常重要的意义。

Objective

To investigate the clinical diagnostic features of viral myocarditis to dilated cardiomyopathy.

Methods

The clinical data of a patient who had a 9-year transformation from viral myocarditis to dilated cardiomyopathy were retrospectively evaluated.

Results

The patient utilized drugs with insufficient treatment and suffered chest tightness and palpitations 5 times after a cold in 9 years. The patient's left ventricular ejection fraction and interventricular septal thickness varied significantly over the course of 9 years, and they have been declining since 2018. In June 2017, a cardiac MRI revealed significant ventricular wall weakening, with a maximal left ventricular end-diastolic diameter of 60.15 mm. The patient′s genetic test results indicated dilated cardiomyopathy, and the DSP gene′s c. 2974-2 A>G site mutation was discovered. The physiology of the heart remained irreversible even after 9 years of the patient taking medication consistently and attempting to avoid disease-relevant triggers.

Conclusions

Patients who carry relevant pathogenic genes are more likely to develop the dilated cardiomyopathy. For the early identification of the cause and the management of illness development, it is crucial to support individualized precision treatment and the early discovery of the associated pathogenic genes.

表1 病毒性心肌炎向扩张型心肌病转变患者9年来主要炎性指标实验室检查结果
图1 病毒性心肌炎向扩张型心肌病转变患者历年心脏彩超结果注:a图示患者9年来左室舒张末期内径及左室射血分数随时间显著上下波动,且射血分数自2018年持续降低;b图示患者9年来左心室后壁厚度及室间隔厚度随时间显著上下波动,且室间隔厚度自2018年持续减低
图2 病毒性心肌炎向扩张型心肌病转变患者心脏磁共振成像检查图像注:心室壁广泛变薄,左室舒张末期内径最大达60.15mm
表2 病毒性心肌炎向扩张型心肌病转变患者基因检测结果
图3 病毒性心肌炎向扩张型心肌病转变患者DSP突变基因测序图谱注:DSP基因c.2794-2 A>G位点突变,黑色主峰下出现绿色次峰,表明发生杂合突变;DSP为桥粒斑蛋白
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