Viêm cơ tim do virus ở trẻ sơ sinh với nghi ngờ tử vong đột ngột

Rechtsmedizin - Tập 18 - Trang 365-376 - 2008
R. Dettmeyer1
1Institut für Rechtsmedizin, Justus-Liebig-Universität, Gießen, Deutschland

Tóm tắt

Viêm cơ tim do virus gây ra có thể dẫn đến tử vong, cũng xảy ra ở trẻ sơ sinh và trẻ em, mặc dù việc chẩn đoán chỉ dựa trên các tiêu chí Dallas có thể gặp khó khăn và bị chỉ trích là không đáng tin cậy. Các phương pháp miễn dịch mô học, bao gồm việc định danh và định lượng các tế bào viêm trong khoảng liên kết cơ tim, cùng với các kỹ thuật bệnh lý phân tử để phát hiện bộ gen virus trong cơ tim, đã cải thiện đáng kể quá trình chẩn đoán. Điều này cũng áp dụng cho các trường hợp tử vong đột ngột và không mong đợi ở trẻ sơ sinh và trẻ nhỏ, đặc biệt là trong các trường hợp có thể xảy ra hội chứng tử vong đột ngột ở trẻ sơ sinh (SIDS), như được minh chứng bởi cái nhìn tổng quan vào các nghiên cứu liên quan. Cụ thể, mẫu cơ tim được lấy từ các nạn nhân SIDS và các trường hợp đối chứng có độ tuổi tương tự với nguyên nhân tử vong không tự nhiên đã được nghiên cứu về mặt bệnh lý phân tử bằng cách sử dụng phương pháp khuếch đại chuỗi polymerase (PCR) hoặc PCR phiên mã ngược (RT-PCR) cho các virus như Enterovirus (EV), Adenovirus (AV), Parvovirus B19 (PVB19), Virus Epstein-Barr (EBV) và Cytomegalovirus (CMV). Các nghiên cứu miễn dịch mô học trên mẫu cơ tim được thực hiện nhằm thể hiện sự hiện diện của các bạch cầu biểu hiện kháng nguyên chung Leucocyte (LCA+), các lymphocyte T CD45R0+ và các đại thực bào CD68+, cũng như xác định dấu hiệu hoại tử sớm C5b–9(m)-complex và protein vỏ virus thể enetrovirus VP1. Một số virus nêu trên đã được phát hiện hoàn toàn chỉ trong cơ tim của những trường hợp SIDS, trong khi tất cả các mẫu từ nhóm đối chứng có độ tuổi tương tự đều có kết quả âm tính với virus. So với các mẫu cơ tim của nhóm đối chứng, các trường hợp SIDS cho thấy sự xâm nhập rõ rệt của các lymphocyte T CD45R0+ trong khoảng liên kết cơ tim, sự xâm nhập gia tăng của các bạch cầu LCA+ và các đại thực bào CD68+. Thêm vào đó là một số trường hợp có sự biểu hiện vi mô của dấu hiệu hoại tử C5b–9(m)-complex và protein vỏ virus enterovirus VP1 trong cơ tim. Sự biểu hiện của các phân tử kháng nguyên bạch cầu người proinflammatory (HLA) loại II (HLA-DP, -DQ, -DR), cũng như E-selectin nội mô, đã được ghi nhận với các mức độ khác nhau. Trên cơ sở các nghiên cứu đã thực hiện, việc phân loại và định lượng miễn dịch của các bạch cầu cơ tim trong khoảng liên kết cũng cho phép đề xuất các ngưỡng chẩn đoán cho trẻ sơ sinh.

Từ khóa

#Viêm cơ tim do virus #Hội chứng tử vong đột ngột ở trẻ sơ sinh #Chẩn đoán #Miễn dịch mô học #Phân tích bệnh lý phân tử

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