Center for Clinical Microbiology, Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre at UCL Hospital, London, United Kingdom.
Department of Laboratory Medicine, Karolinska Institute and CAST (Center for allogeneic stem cell transplantation), Karolinska Hospital, Stockholm, Sweden.
Int J Infect Dis. 2015 Mar;32:30-1. doi: 10.1016/j.ijid.2014.11.017.
TB Pericarditis is associated with significant inflammatory and immune responses which can paradoxically cause injury to the pericardium and myocardium. Management with anti-TB therapy alone does not prevent complications or reduce mortality. Thus the prevailing view is that adjunct host-directed therapies such as use of glucocorticoid treatment could attenuate destructive inflammatory responses and improve morbidity and mortality rates. A recent trial showed no advantage of using adjunct corticosteroid treatment on the combined endpoint of death, cardiac tamponade or constriction. The current lack of effective medical treatment for reducing the significant morbidity and mortality associated with TB pericarditis, highlights the urgent need for newer approaches to treating the disease. Newer treatment options for pericarditis using adjunct host-directed therapies, including autologous bone-marrow-derived Mesenchymal Stromal Cells (MSCs) therapy, now require evaluation in randomized placebo-controlled controlled trials.
结核性心包炎与显著的炎症和免疫反应有关，这些反应可能会导致心包和心肌损伤。单纯使用抗结核治疗并不能预防并发症或降低死亡率。因此，目前的观点认为，辅助宿主导向治疗，如使用糖皮质激素治疗，可以减轻破坏性炎症反应，提高发病率和死亡率。最近的一项试验表明，在死亡、心脏压塞或缩窄的联合终点上，辅助使用皮质类固醇治疗没有优势。目前，缺乏有效的医学治疗方法来降低结核性心包炎相关的高发病率和死亡率，这突显了迫切需要寻找治疗这种疾病的新方法。目前，需要在随机安慰剂对照临床试验中评估使用辅助宿主导向治疗（包括自体骨髓来源的间充质基质细胞（MSCs）治疗）治疗心包炎的新治疗选择。
