Myokarditis im Kindesalter - Forschungsergebnisse einer Dekade

Zusammenfassung.

Die Forschungsergebnisse des letzten Jahrzehnts haben uns im pathogenetischen Verständnis der Myokarditis erheblich vorangebracht. Die Virusinfektion des Myokards kann durch das entzündliche Infiltrat kontrolliert werden, die Myokarditis mit geringer oder deutlicher Narbenbildung ausheilen. Daneben wird eine autoimmunvermittelte chronische Myokarditis beobachtet sowie eine Persistenz des Virusgenoms, das mit geringer Replikationsrate den Entzündungsprozess unterhält. Die immunhistochemische Charakterisierung des Infiltrates sowie der molekularbiologische Nachweis von Virusgenom in der Endomyokardbiopsie ermöglichen eine empfindliche Diagnostik der verschiedenen Formen der Myokarditis, nach denen sich auch die Therapie ausrichten sollte. Bisherige Therapiestudien kranken an der mangelhaften ätiologischen Diagnostik, fehlenden Kontrollgruppen oder kleinen Zahlen. Zwei multizentrische Therapiestudien zur immunsuppressiven und antiviralen Therapie mit Interferon bei Kindern und bei Erwachsenen können bei besserer Beteiligung Therapieempfehlungen geben.

The research of the last decade gave new insights in the pathogenesis of viral myocarditis. The virus infection of the myocardium may be controlled by the infiltrating inflammatory cells and heal with more or less scarring. An autoimmune mediated chronic inflammation is observed as well as the persistence of virus genoms, which causes with low replication rate again chronic inflammation. The immunohistochemical characterization of the infiltrating immune cells and the molecular biological proof of virus genoms in endomyocardial specimens allow a sensitive diagnostic of the various forms of myocarditis and should guide therapy. Until now treatment trials did not differentiate between these various forms, had no control groups or very small numbers of patients. Two multicenter treatment trials in Germany referring to immunosuppressive or interferon therapy in children and adults may give - provided a better participation - recommendations for therapy.

Myokarditis - Kindesalter - Pathogenese - Therapie

myocarditis - infancy and childhood - pathogenesis - treatment

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