Artom Galit, Koren-Morag Nira, Spodick David H, Brucato Antonio, Guindo Joseph, Bayes-de-Luna Antoni, Brambilla Giovanni, Finkelstein Yaron, Granel Brigitte, Bayes-Genis Antoni, Schwammenthal Ehud, Adler Yehuda
Cardiac Rehabilitation Institute, Sheba Medical Centre, Tel-Hashomer 52621, Israel.
Eur Heart J. 2005 Apr;26(7):723-7. doi: 10.1093/eurheartj/ehi197. Epub 2005 Mar 8.
Effective prevention of recurrent pericarditis remains an important yet elusive goal. Corticosteroid therapy often needs to be continued for a prolonged period and causes severe side effects. We performed a multi-centre all-case analysis to investigate the efficacy of colchicine in preventing subsequent relapses of pericarditis, and addressed the hypothesis that pretreatment with corticosteroids may attenuate the beneficial effect of colchicine.
One hundred and forty published and unpublished cases of patients treated with colchicine after at least two relapses of pericarditis were aggregated from European centres. Of those, 119 were included in the study group. Only 18% of the patients had relapses under colchicine therapy, and 30% after its discontinuation. There were significantly more relapses among male patients after colchicine treatment (36 vs. 17%, P=0.046), and those with previous corticosteroid treatment (43 vs. 13%, P=0.02). Multivariate logistic regression analysis identified previous corticosteroid therapy (OR 6.68, 95% CI: 1.65-27.02) and male gender (OR 4.20, 95% CI: 1.16-15.21) as independent risk factors for recurrence following colchicine therapy.
Treatment with colchicine is highly effective in preventing recurrent pericarditis, while pretreatment with corticosteroids exacerbates and extends the course of recurrent pericarditis.
有效预防复发性心包炎仍然是一个重要但难以实现的目标。皮质类固醇疗法通常需要长期持续使用,且会引起严重的副作用。我们进行了一项多中心全病例分析,以研究秋水仙碱在预防心包炎后续复发中的疗效,并探讨皮质类固醇预处理可能会削弱秋水仙碱有益效果的假设。
从欧洲各中心汇总了140例已发表和未发表的在至少两次心包炎复发后接受秋水仙碱治疗的患者病例。其中,119例纳入研究组。在秋水仙碱治疗期间,只有18%的患者复发,停药后复发率为30%。秋水仙碱治疗后男性患者的复发率显著更高(36%对17%,P = 0.046),既往接受过皮质类固醇治疗的患者复发率也更高(43%对13%,P = 0.02)。多变量逻辑回归分析确定既往皮质类固醇治疗(比值比6.68,95%置信区间:1.65 - 27.02)和男性性别(比值比4.20,95%置信区间:1.16 - 15.21)是秋水仙碱治疗后复发的独立危险因素。
秋水仙碱治疗在预防复发性心包炎方面非常有效,但皮质类固醇预处理会加重并延长复发性心包炎的病程。