Imazio Massimo, Cecchi Enrico, Correndo Livio, D'Oulx Emanuele Antonielli, Doronzo Baldassarre, Trinchero Rita
Cardiology Department. Maria Vittoria Hospital, Via Cibrario 72, 10141 Turin, Italy.
J Cardiovasc Med (Hagerstown). 2007 Sep;8(9):748-53. doi: 10.2459/JCM.0b013e3280101e24.
We report a difficult case of a 45-year-old woman with refractory recurrent pericarditis, who was treated with several different medical therapies, pericardial window, and pericardiectomy. This case suggests that more invasive diagnostic and therapeutic choices, such as pericardial window and pericardiectomy, should be carefully considered for possible side-effects and the risk of promoting further recurrences. Non-steroidal anti-inflammatory drugs and colchicine are first-choice drugs, whereas corticosteroids should be considered only in patients with a frequent crisis unresponsive to non-steroidal anti-inflammatory drugs, and by using proper dosage and a careful slow tapering. Patience and appropriate medical therapy are the keys to successful management. In true refractory cases, combination therapy with two or three drugs such as non-steroidal anti-inflammatory drugs, colchicine and corticosteroid may be considered before applying other more complex and less safe treatments. Immunosuppressive drugs and steroid sparing agents might be used, but it should be acknowledged that only weak evidence-based data support their use.
我们报告了一例45岁难治性复发性心包炎女性的疑难病例，该患者接受了多种不同的药物治疗、心包开窗术和心包切除术。该病例表明，对于心包开窗术和心包切除术等侵入性更强的诊断和治疗选择，应仔细考虑其可能的副作用以及促进进一步复发的风险。非甾体类抗炎药和秋水仙碱是首选药物，而仅在对非甾体类抗炎药无反应的频繁发作患者中，且使用适当剂量并谨慎缓慢减量时，才应考虑使用皮质类固醇。耐心和适当的药物治疗是成功管理的关键。在真正的难治性病例中，在应用其他更复杂且安全性较低的治疗方法之前，可考虑使用非甾体类抗炎药、秋水仙碱和皮质类固醇等两三种药物的联合治疗。可能会使用免疫抑制药物和类固醇节约剂，但应认识到仅有薄弱的循证数据支持其使用。
