北京大学人民医院刘文玲

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1、北京大学人民医院刘文玲心肌病与丙型肝炎病毒感染RelationshipbetweenCardiomyopathiesandHepatitisCVirusInfectionCopyrightrestrictionsmayapply.Elliott,P.etal.EurHeartJ200829:270-276;doi:10.1093/eurheartj/ehm342SummaryofproposedclassificationsystemCopyright©2006AmericanHeartAssociationMaron,B.J.etal.

2、Circulation2006;113:1807-1816Primarycardiomyopathiesinwhichtheclinicallyrelevantdiseaseprocessessolelyorpredominantlyinvolvethemyocardium近十年来，丙型肝炎病毒（HCV）感染与心肌炎、心肌病、动脉粥样硬化等心血管疾病相关研究陆续开展，对HCV是否是CVD的相关危险因素进行了深入研究。然而，不同国家（地区）、不同人群的研究结果不尽一致。1995JapanMatsumoriDCM1997JapanOkabeM

3、yocarditis1999JapanTakedaMyocarditis2002JapanFrustaciMyocarditis1996JapanMatsumoriHCMTimeCountryAuthorDisease阳性结论1998GreeceDalekosDCM1998GermanyGrumbachMyocarditis,DCMTimeCountryAuthorDisease阴性结论1999ItalyPratiDCM>20pg/ml≤20pg/mlIncreasedBNP(%)31*25*55.4%*CardiacTroponinT<

4、10pg/ml,TroponinI<100pg/mlPlasmaBNPinPatientswithHCVHepatitisDetectionofNegativeStrandsofHCVRNAintheHeartofaPatientswithDCMbyinsituHybridization×200HCVHepatitisDCMImmunohistochemicalStainingagainstHCVProteinImmunohistochemicalStainingofHCVCoreProteinintheHeartfromPatients

5、withARVC/DChronicInflammationDCMARVC/DHCMHypertrophyHCVInfectionMyocyteLossFibrosisAcuteHepatitisChronicHepatitisLiverCirrhosisMyocardialFibrosisDCMAcuteMyocarditisChronicInflammationHepaticFailureHCCHCM85%20%6%4%HCVHepatitisHCVCardiomyopathiesViralInfectionoftheHeartDiff

6、useCHF/DCMSystolicHFRegionalAneurysmSubendocardialRCMDiastolicHFARVC/DLVAneurysmRandomHypertrophy/HCMVirusReceptorMyocyteFibroblastCompleterecoveryDiffusehypokinesisRegionalabnormalitySubendocardiallesionsIncreasedwallthicknessUnclassifiedabnormalityViralMyocarditisCHF/DC

7、MSystolicHFHCMRCMARVC/DDiastolicHFHepatitisCVirusLVAneurysmARVCHCMDCMMyocarditisMatsumoriACircRes2005;96:144-147我国HCV患者心脏损害的研究我国一般人群抗-HCV阳性率为3.2%，丙型肝炎抗体阳性患者约4000万；与心血管疾病一样，HCV感染也是严重危害人民健康的卫生问题。研究对象病例组：连续选取2006年3月~2007年7月于北京佑安医院及解放军302医院两家三级甲等传染病专科医院诊治的HCV感染患者对照组：随机选取与入选病例

8、年龄、性别、体重匹配的正常健康人作为对照。研究对象◆HCV感染者入选标准①血清抗HCV抗体阳性；②血清HCVRNA阳性；◆HCV感染者排除标准其他肝病、包括艾滋病毒、立克次体或螺旋体在内的其他