心脏结节病患者柯萨奇病毒B抗体高流行率：一项回顾性队列研究
本研究为回顾性观察队列研究，纳入2011至2025年间堪萨斯大学健康系统56例确诊心脏结节病患者，评估CVB抗体阳性率。结果显示91%患者CVB抗体阳性，80%为中高滴度，而外部对照人群阳性率仅14.5%。研究提示CVB血清学可能作为低成本的筛查标志物，帮助识别需进一步行心脏影像检查的患者。
要点
- 56例心脏结节病患者中，91%检出CVB抗体阳性，80%呈中高滴度。
- 外部对照人群CVB阳性率为14.5%，提示心脏结节病与CVB暴露显著相关。
- CVB血清学或可作低成本的筛查工具，但需前瞻性研究验证其临床应用价值。
核心结论
- 本研究显示心脏结节病患者中柯萨奇病毒B抗体阳性率高（91%），且多数呈中高滴度，提示CVB血清学可能作为低成本的筛查生物标志物，帮助识别需进一步行先进心脏影像评估的患者。
研究设计与样本
- 回顾性观察队列研究，纳入2011至2025年间美国堪萨斯大学健康系统中符合心脏结节病诊断标准（心律学会或日本循环学会标准）且行CVB抗体检测的成人患者。
- 共56例确诊心脏结节病患者，数据来自电子病历，包括人口学信息、影像发现、临床特征及CVB抗体滴度。CVB阳性率与外部对照人群（MAVERIC注册及既往人口研究）比较。
主要发现
- 56例患者中51例（91%）CVB抗体阳性，其中80%显示中高滴度。
- 外部对照人群中CVB阳性率为14.5%。
- 晚期影像提示心脏受累：心脏MRI延迟钆增强占78%，PET心肌18-氟脱氧葡萄糖摄取占87%。
- 常规筛查检测敏感性有限：心电图、超声心动图及动态监测异常仅见于少数患者。
关键数值与推荐
- 患者诊断标准：≥18岁，符合心律学会或日本循环学会可能或确诊心脏结节病的标准。
- CVB抗体阳性率：56例中51例（91%），其中80%为中度或高度滴度。
- 外部对照人群CVB阳性率14.5%。
- 心脏MRI延迟钆增强阳性率78%，PET心肌FDG摄取阳性率87%。
临床怎么用
- 临床可考虑将CVB血清学作为低成本筛查工具，用于识别心脏结节病高危患者，以进一步行心脏MRI或PET等先进影像检查。
- 但需注意CVB抗体阳性不能替代确诊性影像，且本研究为回顾性，临床决策应结合患者整体情况。
局限性
- 研究为回顾性设计，样本量小（56例），可能存在选择偏倚。
- 对照组为外部人群而非同期匹配对照，混杂因素未充分控制。
- 研究未提供CVB抗体的敏感性或特异性数值，其作为筛查工具的效能需前瞻性验证。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Objectives Cardiac sarcoidosis (CS) is a potentially life-threatening manifestation of sarcoidosis that is frequently underdiagnosed. Identifying accessible biomarkers that could identify cardiac involvement would improve early detection. Coxsackievirus B (CVB) is proposed as a potential infectious trigger in sarcoidosis, but its relationship to CS remains poorly understood. Methods We conducted a retrospective observational cohort study of patients with CS and available CVB antibody testing at the University of Kansas Health System between 2011 and 2025. Seropositivity was compared with published external comparator cohort populations, including participants from the MAVERIC registry and previously reported population-based studies. Patients ≥18 years who met Heart Rhythm Society or Japanese Circulation Society criteria for probable or definite CS were included. Demographic data, imaging findings, clinical characteristics and CVB antibody titres were extracted from the electronic medical record. Results A total of 56 patients with confirmed CS were included. Overall, 51 of 56 patients (91%) demonstrated CVB antibody positivity, with 80% exhibiting moderate or high titres. In an external comparator cohort population CVB positivity was 14.5%. Advanced imaging findings were consistent with cardiac involvement, including delayed gadolinium enhancement on cardiac MRI in 78% of patients and myocardial 18-fluorodeoxyglucose uptake on positron emission tomography in 87%. Conventional screening tests demonstrated limited sensitivity with abnormalities on ECG, echocardiography and ambulatory monitoring observed in a minority of patients. Conclusions This study demonstrates a high prevalence of CVB antibody positivity among patients with CS. These findings suggest that CVB serology may represent a low-cost screening biomarker to help identify patients who may benefit from further evaluation with advanced cardiac imaging.
引用
- Open Heart：High prevalence of coxsackievirus B antibodies in patients with cardiac sarcoidosis: a retrospective cohort study
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。