扩张型心肌病移植心脏的病毒基因检测及其随访观察

目的　对扩张型心肌病移植心脏受体心肌组织进行多种病毒基因检测 ,并对所有心脏移植后的病人跟踪随访 ,了解病毒感染与移植后心脏的冠脉血管病变间的关系 ,初步判断预后。方法　利用RT PCR及PCR技术检测 12例扩张型心肌病移植受体心脏心肌组织中的多种病毒基因片段。结果　 12例心脏组织中有 7例肠道病毒阳性 ,4例腺病毒阳性 ,1例HCMV阳性 ,2例EBV阳性。而且 ,有的病例在同一组织中可检测到几种病毒 ,且在不同部位。经过 1年多随访 ,初步发现有病毒感染者 ,移植后的心脏冠脉血管发生狭窄的概率高于病毒基因阴性者 ,而且多种病毒混合感染的血管病变较单种病毒更容易发生。结论　病毒感染导致的扩张型心肌病可能是多因素的 ,同时它对移植后心脏的结构、功能改变似乎有一定的影响。

Detection of Various Viruses in Recipient Myocardium of Patients with Dilated Cardiomyopathy during Transplantation and Including Following-up

Purpose To detecte various viruses in myocardium of recipient heart with dilated cardiomyopathy and to evaluate the cardiac allografts for viral infection and determining whether the presence of viral genome in myocardium is correlative with rejection,coronary vasculopathy or graft loss. Methods Twelve patients diagnosed as dilated cardiomyopathy underwent orthotopic cardiac transplantation.Varies viruses were detected in those recipient myocardium tissues by RT?PCR and PCR techniques. Results Viral genome was amplified in 7 (58.3% samples) of 12 patients.Enterovirus was found positive in all of 7 samples,adenovirus in 4,human cytomegalovirus in 2 and epstein barr virus in 2 samples.However,it was inte resting that positive virus genes were detected in different chambers of heart and simultaneous positive for various viruses in the same location.By following up,we found that if the recipient heart existed viral infection,the patients were easier to occur coronary vasculopathy than those hearts that no genome were detec ted. Conclusions The resistance of viral infection probable is related with part of pathogenesis in dilated cardiomyopathy.Meanwhile,it can effect the structure and function for transplantation heart.