Myocarditis is a polymorphic disease complicated with indeterminate etiology and pathogenesis, and represents one of the most challenging clinical problems lacking specific diagnosis and effective therapy. It is caused by a complex interplay of environmental and genetic factors, and causal links between dysregulated microribonucleic acids (miRNAs) and myocarditis have also been supported by recent epigenetic researches. Both dysregulated CD4+ T cells and miRNAs play critical roles in the pathogenesis of myocarditis, and the classic triphasic model of its pathogenesis consists of the acute infectious, subacute immune, and recovery/chronic myopathic phase. CD4+ T cells are key pathogenic factors underlying the development and progression of myocarditis, and the effector and regulatory subsets, respectively, promote and inhibit autoimmune responses. Furthermore, the reciprocal interplay of these subsets influences the pathogenesis as well. Dysregulated miRNAs along with their mRNA and protein targets have been identified in heart biopsies (intracellular miRNAs) and body fluids (circulating miRNAs) during myocarditis. These miRNAs show phase-dependent changes, and correlate with viral infection, immune status, fibrosis, destruction of cardiomyocytes, arrhythmias, cardiac functions, and outcomes. Thus, miRNAs are promising diagnostic markers and therapeutic targets in myocarditis. In this review, we review myocarditis with an emphasis on its pathogenesis, and present a summary of current knowledge of dysregulated CD4+ T cells and miRNAs in myocarditis.

心肌炎是一种多态性疾病，病因和发病机制不明确，是缺乏特异性诊断和有效疗法的最具挑战性的临床问题之一。这是由于环境和遗传因素之间复杂的相互作用所致，最近表观遗传学研究也证实了微核糖核酸（miRNA）失调与心肌炎之间的因果关系。失调的CD4 + T细胞和miRNA在心肌炎的发病机理中都起着关键作用，其发病机理的经典三阶段模型由急性感染性，亚急性免疫性和恢复性/慢性肌病性阶段组成。CD4 + T细胞是心肌炎发展和进程的关键致病因素，效应子和调节子集分别促进和抑制自身免疫反应。此外，这些子集的相互影响也影响发病机理。在心肌活检期间，在心脏活检（细胞内miRNA）和体液（循环miRNA）中已发现miRNA失调及其mRNA和蛋白质靶标。这些miRNA显示出阶段依赖性变化，并与病毒感染，免疫状态，纤维化，心肌细胞破坏，心律不齐，心脏功能和预后相关。因此，miRNA是心肌炎中有希望的诊断标志物和治疗靶标。在这篇综述中，我们回顾了心肌炎的发病机理，并概述了心肌炎中CD4 + T细胞和miRNA失调的最新知识。在心肌活检期间，在心脏活检（细胞内miRNA）和体液（循环miRNA）中已发现miRNA失调及其mRNA和蛋白质靶标。这些miRNA显示出阶段依赖性变化，并与病毒感染，免疫状态，纤维化，心肌细胞破坏，心律不齐，心脏功能和预后相关。因此，miRNA是心肌炎中有希望的诊断标志物和治疗靶标。在这篇综述中，我们回顾了心肌炎的发病机理，并概述了心肌炎中CD4 + T细胞和miRNA失调的最新知识。在心肌炎期间，在心脏活检组织（细胞内miRNA）和体液（循环miRNA）中已经鉴定到失调的miRNA及其mRNA和蛋白质靶标。这些miRNA显示出阶段依赖性变化，并与病毒感染，免疫状态，纤维化，心肌细胞破坏，心律不齐，心脏功能和预后相关。因此，miRNA是心肌炎中有希望的诊断标志物和治疗靶标。在这篇综述中，我们回顾了心肌炎的发病机理，并概述了心肌炎中CD4 + T细胞和miRNA失调的最新知识。破坏心肌细胞，心律不齐，心脏功能和结局。因此，miRNA是心肌炎中有希望的诊断标志物和治疗靶标。在这篇综述中，我们回顾了心肌炎的发病机理，并概述了心肌炎中CD4 + T细胞和miRNA失调的最新知识。破坏心肌细胞，心律不齐，心脏功能和结局。因此，miRNA是心肌炎中有希望的诊断标志物和治疗靶标。在这篇综述中，我们回顾了心肌炎的发病机理，并概述了心肌炎中CD4 + T细胞和miRNA失调的最新知识。