Marcolongo R, Russo R, Laveder F, Noventa F, Agostini C
Department of Clinical Medicine, Padua University School of Medicine, Italy.
J Am Coll Cardiol. 1995 Nov 1;26(5):1276-9. doi: 10.1016/0735-1097(95)00302-9.
This study reviews the clinical outcome of a series of patients with recurrent pericarditis before and after immunosuppressive therapy.
Despite anti-inflammatory treatment, some patients with acute pericarditis experience repeated relapses of the disease. The use of steroids for the treatment of recurrent pericarditis remains controversial.
Twelve patients (4 women, 8 men; mean [+/- SD] age 35.9 +/- 17.2 years, range 15 to 65) with recurrent pericarditis unrelated to any systemic disease were selected. All 12 patients previously received ineffective short-term courses of low dose steroids and had a total of 39 relapses during a mean follow-up period of 14.2 months (range 4 to 50). A 3-month course of treatment with prednisone, at an immunosuppressive dosage, was started (1 to 1.5 mg/kg body weight per day for 4 weeks, then gradually withdrawn). When prednisone reduction was undertaken, all patients started a 5-month course of treatment with aspirin (1.6 g/day until steroid suspension, then reduced to 0.8 g/day).
During a mean follow-up period of 41.6 months (range 7 to 104), immunosuppressive treatment with high dose prednisone resulted in stable remission in all except one patient, who experienced one relapse. In this patient, the addition of azathioprine to prednisone induced a persistent remission, which remained after 1-year follow-up. During treatment, three patients had severe steroid-related adverse effects that in two patients required replacement of prednisone with azathioprine and cyclophosphamide, respectively. This variation in the immunosuppressive regimen did not modify the favorable clinical outcome.
The dose and duration of steroid treatment are critical factors in preventing recurrent pericarditis. High dose prednisone with aspirin should be considered in the treatment of recurrent pericarditis resistant to anti-inflammatory therapy. Cyclophosphamide or azathioprine should be reserved for patients who do not respond to high dose prednisone or who experience severe complications related to steroid therapy.
本研究回顾了一系列复发性心包炎患者在免疫抑制治疗前后的临床结果。
尽管进行了抗炎治疗，但一些急性心包炎患者仍会反复复发。使用类固醇治疗复发性心包炎仍存在争议。
选取12例与任何全身性疾病无关的复发性心包炎患者（4例女性，8例男性；平均[±标准差]年龄35.9±17.2岁，范围15至65岁）。所有12例患者此前均接受过无效的低剂量类固醇短期疗程治疗，在平均14.2个月（范围4至50个月）的随访期内共复发39次。开始为期3个月的泼尼松免疫抑制剂量治疗疗程（每天1至1.5毫克/千克体重，持续4周，然后逐渐减量）。当泼尼松减量时，所有患者开始为期5个月的阿司匹林治疗疗程（每天1.6克，直至停用类固醇，然后减至每天0.8克）。
在平均41.6个月（范围7至104个月）的随访期内，高剂量泼尼松免疫抑制治疗使除1例患者外的所有患者病情稳定缓解，该例患者复发1次。在该患者中，在泼尼松中加用硫唑嘌呤诱导了持续缓解，随访1年后仍保持缓解。治疗期间，3例患者出现严重的类固醇相关不良反应，其中2例患者分别需要用硫唑嘌呤和环磷酰胺替代泼尼松。免疫抑制方案的这种变化并未改变良好的临床结果。
类固醇治疗的剂量和持续时间是预防复发性心包炎的关键因素。对于抗炎治疗耐药的复发性心包炎，应考虑使用高剂量泼尼松联合阿司匹林治疗。环磷酰胺或硫唑嘌呤应保留给对高剂量泼尼松无反应或出现与类固醇治疗相关严重并发症的患者。
