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心臓炎 の 診断,リスク の 階層化,治療: レビュー
Paul C Cremer1, Allan L Klein2, Massimo Imazio3,4
1Division of Cardiology, Bluhm Cardiovascular Institute, Departments of Medicine and Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA
|September 5, 2024
まとめ
急性心膜炎は,しばしばイディオパシーまたはウイルス要因によって引き起こされ,通常NSAIDとコルキシン治療で解消されます. 慢性的な症例では,より長い治療やIL-1阻害剤のような高度な治療が必要となる.
科学分野:
- 心臓病科
- 感染症
背景:
- 急性心膜炎は,非発血性胸痛の緊急診療の頻繁な原因です.
- ほとんどの症例は治療で良性的な経過を呈しますが,収縮性心周炎や心周タンポネードなどの生命を脅かす合併症が発生することがあります.
- 診断は,胸の痛み,心電図の変化,心周流出などの特定の臨床的および診断基準に基づいています.
研究 の 目的:
- 急性心膜炎の診断と治療の概要
- 地理的位置と病因に基づいて原因と治療戦略を区分する.
- 再発性および慢性症例の予後と管理について議論する.
主な方法:
- 4つの主要な基準のうち少なくとも2つの存在に基づいた診断:特徴的な胸痛,心電図の変化,新しい心周流出,心周摩擦.
- 地理的な位置を考慮したエチオロジック評価 (西部の地域におけるイディオパシー/ウイルス性,流行地域における結核).
- 非ステロイド性抗炎症薬 (NSAIDs),コルキシン,コルチコステロイド,インタールキン-1 (IL-1) 阻害剤を含む治療戦略
主要な成果:
- Idiopathic または viral の原因は,北米と西ヨーロッパで最も一般的です. 結核は,流行地域で一般的です.
- NSAIDとコルキシンによる治療は,大部分の患者で好ましい予後を示します.
- 再発率は15%から30%で,一部の患者は長期にわたる病気で,高度な治療が必要である.
結論:
- 急性心膜炎の治療にはNSAIDとコルキシンが用いられ,ほとんどの患者で成功率が高い.
- 結核は特殊な抗結核療法が必要である.
- 再発性および慢性 perikarditisは,効果的な管理のためにコルチコステロイドまたはIL-1阻害剤を必要とします.
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