University of Ottawa Heart Institute, Arrhythmia Service, Division of Cardiology, Department of Medicine, Ottawa, Ontario, Canada.
Can J Cardiol. 2013 Sep;29(9):1034-41. doi: 10.1016/j.cjca.2013.02.004. Epub 2013 Apr 24.
There are no published clinical consensus guidelines or systematic evaluation supporting the use of corticosteroids for the treatment of cardiac sarcoidosis. The purpose of this study was to systematically review the published data on corticosteroid treatment of cardiac sarcoidosis.
Studies were identified from MEDLINE, EMBASE, Cochrane Controlled Trials Register, Cochrane Database of Systematic Reviews, and National Institutes of Health Clinical Trials.gov database. The quality of included articles was rated using Scottish Intercollegiate Guidelines Network 50. Outcomes examined were atrioventricular (AV) conduction, left ventricular function, ventricular arrhythmias, and mortality.
A total of 1491 references were retrieved and 10 publications met the inclusion criteria. There were no randomized trials and all publications were of poor to fair quality. In the 10 reports, 257 patients received corticosteroids and 42 patients did not. There were 57 patients with AV conduction disease treated with corticosteroids, with 27/57 (47.4%) improving. In contrast, 16 patients were not treated with corticosteroids and 0/16 improved. Four publications reported on left ventricular function recovery, 2 reported on ventricular arrhythmia burden, and 9 reported on mortality. However, the data quality were too limited to draw conclusions for any of these outcomes.
Our systematic review identified 10 publications reporting outcomes after corticosteroid therapy. The best data relates to AV conduction recovery and corticosteroids appeared to be beneficial. It is not possible to draw clear conclusions about the utility of corticosteroids for the other outcomes. There is a clear need for large multicentre prospective registries and trials in this patient population.
目前尚无关于皮质类固醇治疗心脏结节病的临床共识指南或系统评价。本研究旨在系统回顾皮质类固醇治疗心脏结节病的已发表数据。
从 MEDLINE、EMBASE、Cochrane 对照试验登记处、Cochrane 系统评价数据库和美国国立卫生研究院临床试验数据库中检索研究。使用苏格兰校际指南网络 50 对纳入文章的质量进行评分。评估的结局包括房室（AV）传导、左心室功能、室性心律失常和死亡率。
共检索到 1491 篇参考文献，10 篇文献符合纳入标准。没有随机试验，所有文献的质量均较差或一般。在这 10 项研究中，257 例患者接受了皮质类固醇治疗，42 例患者未接受治疗。57 例 AV 传导疾病患者接受皮质类固醇治疗，27/57（47.4%）改善。相比之下，16 例未接受皮质类固醇治疗的患者无一例改善。有 4 项研究报告了左心室功能恢复情况，2 项研究报告了室性心律失常负担，9 项研究报告了死亡率。然而，数据质量太差，无法对任何这些结局得出结论。
我们的系统综述确定了 10 项报告皮质类固醇治疗后结局的研究。关于 AV 传导恢复的最佳数据表明皮质类固醇可能有益。对于其他结局，无法明确皮质类固醇的效用。在该患者人群中，非常需要大型多中心前瞻性登记和试验。
