Nagai Toshiyuki, Nagano Nobutaka, Sugano Yasuo, Asaumi Yasuhide, Aiba Takeshi, Kanzaki Hideaki, Kusano Kengo, Noguchi Teruo, Yasuda Satoshi, Ogawa Hisao, Anzai Toshihisa
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center.
Circ J. 2015;79(7):1593-600. doi: 10.1253/circj.CJ-14-1275. Epub 2015 Apr 16.
Cardiac involvement is the worst prognostic determinant in patients with sarcoidosis, but the long-term prognostic significance of corticosteroid therapy for cardiac sarcoidosis (CS) remains unclear.
We examined 83 consecutive patients diagnosed with CS. Patients were divided into 2 groups based on the presence or absence of corticosteroid therapy at diagnosis. Patients with corticosteroid therapy had lower age and higher rate of positive findings in the myocardium on gallium scintigraphy (Ga) at diagnosis than those without. LVEF, biomarkers, and use of cardiovascular medication were similar between the 2 groups. During the follow-up (7.6±4.4 years), corticosteroid therapy was associated with fewer long-term adverse events (overall, P=0.005; cardiac death, P=0.92; symptomatic arrhythmias, P=0.89; heart failure admission, P<0.0001) and a greater % increase in LVEF than those without (7.9±36.3% vs. -16.7±34.8%, P=0.03). On Cox proportional hazards modeling, corticosteroid therapy (HR, 0.41; 95% CI: 0.20-0.89) was an independent determinant of long-term adverse event-free survival, but age, sex, LVEF, and Ga findings were not.
Corticosteroid therapy might have a beneficial effect on long-term clinical outcome in CS patients, particularly by reduction of heart failure admission and retarding the progression of LV systolic dysfunction.
心脏受累是结节病患者预后最差的决定因素，但皮质类固醇疗法对心脏结节病（CS）的长期预后意义仍不明确。
我们对83例连续诊断为CS的患者进行了检查。根据诊断时是否接受皮质类固醇治疗将患者分为两组。接受皮质类固醇治疗的患者在诊断时年龄较低，镓闪烁扫描（Ga）显示心肌阳性结果的比例高于未接受治疗的患者。两组之间的左心室射血分数（LVEF）、生物标志物和心血管药物的使用情况相似。在随访期间（7.6±4.4年），与未接受皮质类固醇治疗的患者相比，接受该治疗的患者长期不良事件较少（总体上，P=0.005；心源性死亡，P=0.92；有症状的心律失常，P=0.89；心力衰竭入院，P<0.0001），LVEF的增加百分比更高（7.9±36.3%对-16.7±34.8%，P=0.03）。在Cox比例风险模型中，皮质类固醇治疗（风险比，0.41；95%置信区间：0.20-0.89）是长期无不良事件生存的独立决定因素，但年龄、性别、LVEF和Ga检查结果不是。
皮质类固醇疗法可能对CS患者的长期临床结局有有益影响，特别是通过减少心力衰竭入院和延缓左心室收缩功能障碍的进展。
