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心脏炎的诊断,风险分层和治疗:一篇综述
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
概括
急性心膜炎通常由异常或病毒因素引起,通常通过NSAID和素治疗得到缓解. 慢性病例可能会复发,需要更长时间的治疗或先进的治疗,如IL-1阻断剂.
科学领域:
- 心脏病学
- 传染性疾病
背景情况:
- 急性心膜炎是非缺血性胸痛的急诊室的常见原因.
- 虽然大多数病例的治疗过程是良性的,但可能会出现危及生命的并发症,如心膜收缩和心膜栓塞.
- 诊断依赖于特定的临床和诊断标准,包括胸痛,心电图变化和心周溢血.
研究的目的:
- 概述急性心膜炎的诊断和治疗方法.
- 根据地理位置和病因学区分原因和治疗策略.
- 讨论复发和慢性病例的预后和管理.
主要方法:
- 基于四个关键标准中的至少两个存在的诊断:特征性胸痛,心电图变化,新的心周溢出或心周摩擦.
- 考虑到地理位置的病因评估 (西部地区的异常/病毒性,流行地区的结核病).
- 治疗策略包括非类固醇抗炎药物 (NSAID),胆固醇,皮质类固醇和介质素-1 (IL-1) 抑制剂.
主要成果:
- 在北美和西欧最常见的原因是病原性或病毒性;结核病在流行地区普遍存在.
- 在大多数患者中,用NSAIDs和colchicine治疗导致预后良好.
- 复发率在15%至30%之间,一些患者患有长期的疾病,需要先进的治疗.
结论:
- 治疗急性心膜炎需要使用NSAID和素,大多数患者的成功率很高.
- 结核需要特殊的抗结核疗法.
- 再发性和慢性心膜炎可能需要皮质类固醇或IL-1抑制剂进行有效的治疗.
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