Corticosteroids for viral myocarditis

 

Abstract

Background

Myocarditis is an uncommon heart disease. There is experimental evidence showing that autoimmune mechanisms follow viral infection, resulting in inflammation and necrosis in myocardium. However, the use of corticosteroids as immunosuppressives in this condition remains controversial.

Objectives

To assess the beneficial and harmful effects of treating viral myocarditis with corticosteroids.

Search methods

Trials were identified by searching The Cochrane Heart Group Register ( to April 2004), the Cochrane Library (Issue 4, 2003), and MEDLINE, EMBASE, BIOSIS for meeting abstracts, LILACS, and Chinese Biomedical CD Database from their date of inception to April 20, 2004. Four Chinese medical journals were handsearched. A total of 507 articles were found but none of them was eligible to be included in our review.

Selection criteria

Randomised controlled trials of corticosteroids for viral myocarditis compared with no intervention, placebo, supportive therapy, antiviral agents therapy or conventional therapy, including trials of corticosteroids plus other treatment versus other treatment alone, irrespective of blinding, publication status, or language.

Data collection and analysis

Two reviewers extracted data independently. We asked authors of trials to provide information when diagnosis or methodology was unclear or data were incomplete. Results were presented as risk ratios (RR) and weighted mean differences (WMD), both with 95% confidence intervals (CI).

Main results

No randomised controlled trials of corticosteroids for viral myocarditis were found that met our inclusion criteria.

Authors' conclusions

There is no randomised evidence to support the use of corticosteroids for viral myocarditis. Further clinical trials are needed.

 

Plain language summary

Corticosteroids may be effective in treating people with viral myocarditis

Viral infection occasionally triggers myocarditis (inflammation and necrosis of the heart muscle) which can result in severe, acute heart failure. The first signs of this condition may be flu-like symptoms which evolve into non-specific chest discomfort, shortness of breath or palpitations. The majority of patients recover spontaneously but others have continuing heart problems which require medication and can be severe enough to cause death.

Corticosteroids may suppress the inflammatory immune response to viral infection and improve outcomes but their use remains controversial. The review authors made a thorough search of the medical literature. No randomised trials which met the inclusion criteria compared corticosteroids with placebo, supportive therapy, antiviral therapy or conventional therapy, including trials of corticosteroids plus other treatment versus other treatment alone, for viral myocarditis.
Trials identified failed to use appropriate diagnostic criteria, were of poor methodological quality or used corticosteroids with additional Chinese traditional medicines in addition, which the control group did not receive. The reviewers concluded that further RCTs comparing corticosteroids in patients suffering viral myocarditis with placebo are warranted.

 

摘要

背景

類固醇用於病毒性心肌炎的治療

心肌炎是一種不常見的心臟疾病。實驗顯示病毒感染可能引起自體免疫反應，進而導致心肌的發炎與壞死。然而，使用類固醇進行免疫抑制治療還是有爭議。

目標

評估用類固醇治療病毒性心肌炎的利與弊。

搜尋策略

搜尋截至2004年4月為止的Cochrane Heart Group Register，2003年第4期的Cochrane Library，MEDLINE，EMBASE，BIOSIS，LILACS，創刊至2004年4月20日的Chinese Biomedical CD Database。人工搜尋四種中文醫學期刊。找到507篇論文，可是沒有一篇符合我們的要求。

選擇標準

治療病毒性心肌炎的隨機對照試驗，比較類固醇治療與不治療、安慰劑、支持療法、抗病毒藥物、和傳統治療、包括類固醇合併其他療法與單獨使用其他療法的比較。不管試驗是否有單盲雙盲，是否已出版，且不管何種語言。

資料收集與分析

2個評論者各自獨立擷取數據。如果診斷，試驗方法，或數據不完整，我們要求作者提供更完整的資訊。 試驗數據以風險比 (risk ratios, RR)， 加權平均差 (mean differences, WMD)，及其95%信賴區間來呈現。

主要結論

沒有使用類固醇於治療病毒性心肌炎的隨機對照試驗符合我們的納入條件。

作者結論

沒有隨機試驗證據支持使用類固醇治療病毒性心急炎。需要進一步進行臨床試驗。

翻譯人

本摘要由臺北榮民總醫院傅俊翔翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

類固醇可能可用於治療病毒性心肌炎。病毒感染偶爾會引起心肌炎(心臟肌肉之發炎及壞死)，導致嚴重的急性心衰竭。首先看到的徵象是類感冒症狀，然後演變成非特異性的胸悶、呼吸急促或心悸。多數病人會自動痊癒，可是有些病人有持續的心臟症狀，需要藥物控制，嚴重可能導致死亡。類固醇可能可以抑制病毒引發的免疫發炎反應，改善病情，可是它們的使用仍有爭議。完整搜尋醫學文獻後，找不到符合我們的納入條件的隨機臨床試驗，比較類固醇與安慰劑、 支持性療法、抗病毒藥物、傳統治療等在病毒性心肌炎的治療效果，包括類固醇合併其他治療與只用其他治療的比較。一些臨床試驗沒有使用適當的診斷標準，試驗方法有瑕疵，或是合併使用控制組中沒有使用到的中草藥。結論是，需要進一步的隨機對照試驗，比較類固醇與安慰劑在病毒性心肌炎的治療效果。