Plasma Concentrations of Cytokines and Neurohumoral Factors in a Case of Fulminant Myocarditis Successfully Treated With Intravenous Immunoglobulin and Percutaneous Cardiopulmonary Support
| Autor: | Takeshi Kashimura, Manabu Hayashi, Yuji Okura, Haruo Hanawa, Kouji Shimada, Ryu Kazama, Satoru Watanabe, Keisuke Suzuki, Go Hasegawa, Makoto Hoyano, Hitoshi Tachikawa, Tsuyoshi Yoshida, Makoto Kodama, Takuya Ozawa, Yoshifusa Aizawa, Kiminori Kato, Takashi Saigawa, Satoru Abe, Masayuki Nagahashi, Junzo Watanabe |
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| Rok vydání: | 2004 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Myocarditis Fulminant Cardiology Coxsackievirus Infections Gastroenterology Proinflammatory cytokine Internal medicine medicine Humans Creatine Kinase Neurotransmitter Agents biology business.industry Myocardium Osmolar Concentration Immunoglobulins Intravenous Interleukin Heart General Medicine Middle Aged Brain natriuretic peptide medicine.disease Immunohistochemistry biology.protein Cytokines Tumor necrosis factor alpha Creatine kinase Antibody Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation Journal. 68:1223-1226 |
| ISSN: | 1347-4820 1346-9843 |
| DOI: | 10.1253/circj.68.1223 |
| Popis: | A 53-year-old Japanese man with fulminant myocarditis was referred. Percutaneous cardiopulmonary support (PCPS) was introduced immediately and intravenous immunoglobulin (IVIG) therapy followed for 2 days. Cardiac function showed signs of recovery on the 4th hospital day and the patient was weaned from PCPS on the 7th hospital day. Creatine kinase-MB peaked at 12 h after admission and was 176 ng/ml. Endomyocardial biopsy showed active myocarditis. A marked increase of the neutralizing antibody titer suggested coxsackievirus B3 infection. Plasma concentrations of cytokines and neurohumoral factors were analyzed. Proinflammatory cytokines, such as interleukin (IL)-1beta, IL-6 and tumor necrosis factor (TNF-alpha), and anti-inflammatory cytokines, such as IL-1 receptor antagonist, soluble TNF receptor-1 and IL-10, were elevated on admission and all had decreased on the 7th hospital day. Brain natriuretic peptide and noradrenaline were already elevated upon admission (1,940 pg/ml and 4.6 ng/ml, respectively) and decreased thereafter. Although IVIG therapy under PCPS is a common treatment for fulminant myocarditis, the immunological response in vivo remains unclear. This case demonstrated suppression of serum cytokines after IVIG and PCPS treatment. Immunological parameters in those who have been treated with IVIG and PCPS and survived without complications are of great value for evaluation of the therapy. Further analysis with more cases in a multicenter study is necessary. |
| Databáze: | OpenAIRE |
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