Sun S, Zhao M, Cui Y X, Song J, Chen J T, Chen H, Song J X
Department of Cardiology, Peking University People's Hospital, Beijing 100044, China.
Department of Pharmacy, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2025 Jul 24;53(7):769-775. doi: 10.3760/cma.j.cn112148-20250210-00096.
To summarize and analyze the clinical characteristics and treatment outcomes of patients with recurrent pericarditis. This observational study consecutively recruited patients with recurrent pericarditis who were hospitalized at Peking University People's Hospital between January 2017 and February 2024. Clinical characteristics and treatment outcomes were collected and summarized during follow-up. A total of 8 recurrent pericarditis patients including 3 males were included, with an age of 34.0 (22.0, 39.5) years. In terms of clinical features, all patients presented with acute-onset severe chest pain, accompanied by fever in 7 and an audible pericardial friction rub in 2 patients. Electrocardiogram showed no diffuse ST-segment elevation or PR-segment depression in any patient. Echocardiography revealed pericardial effusion in all cases, with extensive fibrinous exudate and transient pericardial thickening observed in 6 patients. CT identified concurrent pleural and/or peritoneal effusions in 6 patients. All patients exhibited marked elevations in C-reactive protein, erythrocyte sedimentation rate and D-dimer levels. Whole-exome sequencing identified MEFV gene mutations associated with familial Mediterranean fever in 3 cases. Two patients developed cardiac tamponade requiring pericardiocentesis, which revealed hemorrhagic effusion. In the aspect of treatment outcomes, the time from recurrence to first confirmed diagnosis of recurrent pericarditis of this cohort was 14.5 (13.3, 19.5) d. Upon diagnosis, all patients promptly received standard anti-inflammatory therapy with ibuprofen and colchicine, achieving rapid relief. However, during a follow-up of 12.0 (6.0, 25.3) months, 3 patients experienced recurrence, and 2 developed transient constrictive pericarditis. Patients with recurrent pericarditis typically exhibit characteristic clinical presentations, laboratory abnormalities, imaging findings and potential genetic associations. Although standard anti-inflammatory therapy demonstrates favorable short-term efficacy, long-term management remains challenging due to the risks of recurrence and progression to constrictive pericarditis.
总结并分析复发性心包炎患者的临床特征及治疗结果。本观察性研究连续纳入了2017年1月至2024年2月期间在北京大 学人民医院住院的复发性心包炎患者。随访期间收集并总结临床特征及治疗结果。共纳入8例复发性心包炎患者,其中男性3例,年龄为34.0(22.0,39.5)岁。临床特征方面,所有患者均急性起病,表现为严重胸痛,7例伴有发热,2例可闻及心包摩擦音。心电图检查未发现任何患者有弥漫性ST段抬高或PR段压低。超声心动图显示所有病例均有心包积液,6例观察到广泛的纤维蛋白渗出和短暂的心包增厚。CT检查发现6例患者合并胸腔和/或腹腔积液。所有患者的C反应蛋白、红细胞沉降率和D-二聚体水平均显著升高。全外显子测序在3例患者中发现与家族性地中海热相关的MEFV基因突变。2例患者发生心脏压塞,需要进行心包穿刺,抽出的是血性积液。治疗结果方面,该队列从复发到首次确诊复发性心包炎的时间为14.5(13.3,19.5)天。确诊后,所有患者立即接受布洛芬和秋水仙碱的标准抗炎治疗,症状迅速缓解。然而,在12.0(6.0,25.3)个月的随访期间,3例患者复发,2例发展为短暂性缩窄性心包炎。复发性心包炎患者通常表现出特征性的临床表现、实验室异常、影像学表现及潜在的遗传关联。尽管标准抗炎治疗显示出良好的短期疗效,但由于存在复发和进展为缩窄性心包炎的风险,长期管理仍然具有挑战性。