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复发性心包炎

Authors
Yehuda Adler, MD
Massimo Imazio, MD, FESC
Section Editors
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Jae K Oh, MD
Deputy Editor
Brian C Downey, MD, FACC
Translators
富华颖, 副主任医师

引言

复发性心包炎是一种常见疾病，不论对心包疾病专家还是一般内科医生和家庭医生而言，它都是一个令人头痛的问题。复发性心包炎是指引起最初急性发作的病因消失或不再活跃后再次出现急性心包炎的一种综合征。

复发性心包炎，包括其定义、已提出的发病机制、临床表现、诊断和治疗，将总结在此。首次出现急性心包炎的患者的临床表现、诊断和治疗将单独讨论。 (参见“急性心包炎的临床表现及诊断评估”和“急性心包炎的治疗”)

定义

急性心包炎的主要临床表现为：胸痛、心包摩擦感、心电图(electrocardiogram, ECG)显示广泛马鞍形或凹面向上的ST段抬高，以及心包积液[1]。通常应该存在至少2项这类特征才能做出诊断。急性心包炎的临床表现将在别处作更详细的讨论。 (参见下文‘临床表现’和“急性心包炎的临床表现及诊断评估”，关于‘临床特征’一节)

复发性心包炎表现为急性心包炎症状的复发(表 1)；然而，复发性心包炎的主要特征通常为胸痛，并且可能没有急性心包炎的其他临床表现。复发性心包炎是指引起最初急性发作的病因消失或不再活跃后急性心包炎再次出现的一种综合征[2-5]。之前的急性心包炎症状消失后，症状的复发可能会出现在任何时间点，但通常发生于数周至数月后。一般而言，人们主观地规定为距最初发作或上次发作6周。而6周内存在无休止性或持续性症状的病例被认为是“无休止性心包炎”，而非“复发性心包炎”。

秋水仙碱治疗复发性心包炎(Colchicine for Recurrent Pericarditis, CORE)试验纳入了120例复发性心包炎患者，以评估秋水仙碱的治疗效果，该试验要求患者同时满足以下2个临床标准才算符合复发性心包炎的定义[6]：

                           

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-18.
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