Imazio Massimo, Brucato Antonio, Pluymaekers Nikki, Breda Luciana, Calabri Giovanni, Cantarini Luca, Cimaz Rolando, Colimodio Filomena, Corona Fabrizia, Cumetti Davide, Cuccio Chiara Di Blasi Lo, Gattorno Marco, Insalaco Antonella, Limongelli Giuseppe, Russo Maria Giovanna, Valenti Anna, Finkelstein Yaron, Martini Alberto
aCardiology Department, Maria Vittoria Hospital and University of Torino, Torino bInternal Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy cMaastricht University, Faculty of Medicine, Maastricht, the Netherlands dPediatrics Department, University of Chieti, Chieti eRheumatology Department, University of Siena, Siena fMeyer Children Hospital, Firenze gUOS Reumatologia Pediatrica - Fondazione IRCCS Ca' Granda Milan, Milan, Italy hDivision of Rheumatology, Department of Paediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome iCardiology Department, Monaldi Hospital, Second University of Naples, Naples jUniversity of Genoa and Pediatria II Istituto Gianna Gaslini, Genova, Italy kDivisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada *Drs. Finkelstein and Martini are cosenior authors.
J Cardiovasc Med (Hagerstown). 2016 Sep;17(9):707-12. doi: 10.2459/JCM.0000000000000300.
Limited data are available about recurrent pericarditis in children. We sought to explore contemporary causes, characteristics, therapies and outcomes of recurrent pericarditis in paediatric patients.
A multicentre (eight sites) cohort study of 110 consecutive cases of paediatric patients with at least two recurrences of pericarditis over an 11-year period (2000-2010) [median 13 years, interquartile range (IQR) 5, 69 boys].
Recurrences were idiopathic or viral in 89.1% of cases, followed by postpericardiotomy syndrome (9.1%) and familial Mediterranean fever (0.9%). Recurrent pericarditis was treated with nonsteroidal anti-inflammatory drugs (NSAIDs) in 80.9% of cases, corticosteroids in 64.8% and colchicine was added in 61.8%. Immunosuppressive therapies were administered in 15.5% of patients after subsequent recurrences. After a median follow-up of 60th months, 528 subsequent recurrences were recorded (median 3, range 2-25). Corticosteroid-treated patients experienced more recurrences (standardized risk of recurrence per 100 person-years was 93.2 for patients treated with corticosteroids and 45.2 for those without), side effects and disease-related hospitalizations (for all P < 0.05). Adjuvant therapy with colchicine was associated with a decrease in the risk of recurrence from 3.74 per year before initiation of colchicine to 1.37 per year after (P < 0.05). Anakinra therapy (n = 12) was associated with a drop in the number of recurrences from 4.29 per year before to 0.14 per year after (P < 0.05). Transient constrictive pericarditis developed in 2.7% of patients.
Recurrent pericarditis has an overall favourable prognosis in children, although it may require frequent readmissions and seriously affect the quality of life, especially in patients treated with corticosteroids. Colchicine or anakinra therapies were associated with significant decrease in the risk of recurrence.
关于儿童复发性心包炎的数据有限。我们试图探讨当代儿科患者复发性心包炎的病因、特征、治疗方法及预后。
一项多中心（8个地点）队列研究，纳入了110例在11年期间（2000 - 2010年）至少有两次心包炎复发的儿科患者[中位年龄13岁，四分位间距（IQR）5，69名男孩]。
89.1%的病例复发为特发性或病毒性，其次是心包切开术后综合征（9.1%）和家族性地中海热（0.9%）。80.9%的病例采用非甾体抗炎药（NSAIDs）治疗复发性心包炎，64.8%使用皮质类固醇，61.8%加用秋水仙碱。15.5%的患者在随后复发后接受免疫抑制治疗。中位随访60个月后，记录到528次后续复发（中位3次，范围2 - 25次）。接受皮质类固醇治疗的患者复发次数更多（每100人年的标准化复发风险，接受皮质类固醇治疗的患者为93.2，未接受治疗的患者为45.2），副作用及与疾病相关的住院率更高（所有P<0.05）。秋水仙碱辅助治疗使复发风险从开始使用秋水仙碱前的每年3.74次降至之后的每年1.37次（P<0.05）。阿那白滞素治疗（n = 12）使复发次数从之前的每年4.29次降至之后的每年0.14次（P<0.05）。2.7%的患者发生了短暂性缩窄性心包炎。
儿童复发性心包炎总体预后良好，尽管可能需要频繁再次入院且严重影响生活质量，尤其是接受皮质类固醇治疗的患者。秋水仙碱或阿那白滞素治疗可使复发风险显著降低。
