Kim Min Sun, Chang Sung A, Kim Eun Kyoung, Choi Jin Oh, Park Sung Ji, Lee Sang Chol, Park Seung Woo, Oh Jae K
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA.
Korean Circ J. 2020 Jul;50(7):599-609. doi: 10.4070/kcj.2019.0317. Epub 2020 Jan 20.
In East Asia, tuberculous pericarditis still occurs in immunocompetent patients. We aimed to investigate clinical course of tuberculous pericarditis and the trends of echocardiographic parameters for constrictive pericarditis.
We retrospectively analyzed medical records of patients with tuberculous pericarditis between January 2010 and January 2017 in Samsung Medical Center. Treatment consists of the standard 4-drug anti-tuberculosis regimen for 6 months with or without corticosteroids. We performed echocardiography at initial diagnosis, 1, 3 and 6 months later.
Total 50 cases with tuberculous pericarditis in immunocompetent patients were enrolled. Echocardiographic finding at initial diagnosis divided into 3 groups: 1) pericardial effusion only (n=28, 56.0%), 2) effusive constrictive pericarditis (n=10, 20.0%) and 3) constrictive pericarditis (n=12, 24.0%). The proportion of patients with constrictive pericarditis decreased gradually over time. After 6 months, only 5 patients still had constrictive pericarditis. Out of the 28 patients who initially presented with effusion alone, only one patient developed constrictive pericarditis. Echocardiographic parameters representing constrictive pericarditis gradually disappeared over the follow up period. Ventricular interdependency improved significantly from 1 month follow-up, whereas septal bounce and pericardial thickening were still observed after 6 months without significant constrictive physiology.
Tuberculous pericarditis with pericardial effusion without constrictive physiology is unlikely to develop into constrictive pericarditis in immunocompetent hosts, if treated with optimal anti-tuberculous medication and steroid therapy. Even though there were hemodynamic feature of constrictive pericarditis, more than 80% of the patients were improved from constrictive pericarditis.
在东亚地区，免疫功能正常的患者仍会发生结核性心包炎。我们旨在研究结核性心包炎的临床病程以及缩窄性心包炎的超声心动图参数变化趋势。
我们回顾性分析了2010年1月至2017年1月在三星医疗中心就诊的结核性心包炎患者的病历。治疗采用标准的四联抗结核方案，疗程6个月，部分患者联合使用或不使用皮质类固醇。在初始诊断时、1个月、3个月和6个月后进行超声心动图检查。
共纳入50例免疫功能正常的结核性心包炎患者。初始诊断时的超声心动图表现分为3组：1）仅心包积液（n = 28，56.0%），2）渗出性缩窄性心包炎（n = 10，20.0%），3）缩窄性心包炎（n = 12，24.0%）。缩窄性心包炎患者的比例随时间逐渐下降。6个月后，仅有5例患者仍为缩窄性心包炎。最初仅表现为积液的28例患者中，只有1例发展为缩窄性心包炎。代表缩窄性心包炎的超声心动图参数在随访期间逐渐消失。心室相互依赖在随访1个月时显著改善，而6个月后仍观察到室间隔跳动和心包增厚，但无明显的缩窄性生理改变。
对于免疫功能正常的宿主，若采用最佳抗结核药物和类固醇治疗，无缩窄性生理改变的心包积液性结核性心包炎不太可能发展为缩窄性心包炎。即使存在缩窄性心包炎的血流动力学特征，超过80%的患者缩窄性心包炎病情仍有所改善。
