Imazio Massimo
Cardiology Department, Maria Vittoria Hospital and University of Torino, Via Luigi Cibrario 72, 10141, Torino, Italy,
Curr Cardiol Rep. 2015;17(4):23. doi: 10.1007/s11886-015-0575-y.
Clinical trials in the last decade have improved the quality of evidence to support preventive medical strategies to reduce the risk of recurrences after pericarditis. There are essentially three main strategies: (1) to use full anti-inflammatory doses for the treatment of each attack of pericarditis till symptoms resolution and normalization of markers of inflammation (i.e., C-reactive protein); (2) to limit the use of corticosteroids and, if used, to use low to moderate doses (i.e., prednisone 0.2 to 0.5 mg/kg/day or equivalent) followed by slow tapering; and (3) to add colchicine to improve the response to conventional anti-inflammatory therapies and reduce the risk of recurrences. Recommended regimens include weight-adjusted doses (i.e., 0.5-0.6 mg twice daily for patients weighing >70 kg or 0.5-0.6 mg once daily for patients weighing ≤70 kg for 3 months for acute pericarditis and 6 months for recurrences) without a loading dose to improve patients' compliance. Using these doses and appropriate selection of patients (e.g. to avoid severe renal impairment or adjust doses according to comorbid conditions and concomitant therapies), the drug is well tolerated, may cause reversible gastrointestinal intolerance (mainly diarrhea) in about 8 to 10% of cases but has no severe side effects.
过去十年的临床试验提高了证据质量，以支持预防医学策略来降低心包炎后复发风险。基本上有三种主要策略：（1）对每次心包炎发作采用足量抗炎剂量进行治疗，直至症状缓解且炎症标志物（即C反应蛋白）恢复正常；（2）限制使用皮质类固醇，若使用则采用低至中等剂量（即泼尼松0.2至0.5mg/kg/天或等效剂量），随后缓慢减量；（3）加用秋水仙碱以改善对传统抗炎疗法的反应并降低复发风险。推荐方案包括根据体重调整剂量（即体重>70kg的患者每日两次，每次0.5 - 0.6mg；体重≤70kg的患者每日一次，每次0.5 - 0.6mg，急性心包炎治疗3个月，复发时治疗6个月），无需负荷剂量以提高患者依从性。使用这些剂量并适当选择患者（例如避免严重肾功能损害或根据合并症和伴随治疗调整剂量），该药物耐受性良好，约8%至10%的病例可能会出现可逆性胃肠道不耐受（主要是腹泻），但无严重副作用。
