系统性硬化症患者中剂量类固醇治疗后心肌炎的临床结局:一项初步研究。

IF 2.3 Q2 RHEUMATOLOGY
International Journal of Rheumatology Pub Date : 2020-12-19 eCollection Date: 2020-01-01 DOI:10.1155/2020/8884442
Burabha Pussadhamma, Thapanee Tipparot, Naruemol Chaosuwannakit, Ajanee Mahakkanukrauh, Siraphop Suwannaroj, Ratanavadee Nanagara, Chingching Foocharoen
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引用次数: 8

摘要

背景:系统性硬化症(SSc)中有心肌炎的报道;然而,治疗选择和结果是有限的。我们的目的是确定SSc合并心肌炎患者中剂量类固醇治疗后的心脏预后。方法:对伴有心血管磁共振(CMR)定义的SSc心肌炎患者进行开放标签研究。结果:共纳入20例SSc患者,其中12例患者完成了研究。24周时,12例患者中有8例心肌炎好转。与无改善的患者相比,这8例患者的病程明显延长(p = 0.03),基线心率(p = 0.049)和第24周心率(p = 0.04)明显提高,基线左心室(LV)和右心室(RV)搏量降低(p = 0.002和p = 0.01)和第24周(p = 0.01和p = 0.02),第24周左心室和右心室心输出量降低(p = 0.01和p = 0.01)。随访期间死亡4例,其中心脏并发症3例,肾危象1例。死于心力衰竭的2例患者有非常高的nt -原激素-脑钠肽(NT-proBNP)和左室射血分数(LVEF),而死于心律失常的1例患者有非常高的心肌肌钙蛋白- t (hs-cTnT)敏感性。结论:中等剂量类固醇治疗可改善SSc心肌炎。一部分患者在治疗期间死于心脏并发症,特别是那些高hs-cTnT、高NT-proBNP和LVEF受损的患者。本试验注册号为NCT03607071。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Clinical Outcomes of Myocarditis after Moderate-Dose Steroid Therapy in Systemic Sclerosis: A Pilot Study.

Clinical Outcomes of Myocarditis after Moderate-Dose Steroid Therapy in Systemic Sclerosis: A Pilot Study.

Clinical Outcomes of Myocarditis after Moderate-Dose Steroid Therapy in Systemic Sclerosis: A Pilot Study.

Background: Myocarditis is reported in systemic sclerosis (SSc); however, treatment options and outcomes are limited. Our objective was to define cardiac outcomes after moderate-dose steroid therapy in SSc patients with myocarditis.

Method: An open-label study was conducted among SSc patients with myocarditis-as defined by cardiovascular magnetic resonance (CMR), disease onset <5 years, and a NYHA functional class ≥II. All enrolled patients received prednisolone (30 mg/d) which would be tapered off by week 24, and CMR was followed up at the end of treatment.

Results: A total of 20 SSc patients were enrolled which 12 patients completed the study. At week 24, 8 of the 12 cases experienced improvement of myocarditis. Compared to those with no improvement, these 8 patients had significantly longer disease duration (p = 0.03), higher heart rate at baseline (p = 0.049) and week 24 (p = 0.04), lower left ventricular (LV) and right ventricular (RV) stroke volume at baseline (p = 0.002 and p = 0.01) and week 24 (p = 0.01 and p = 0.02), and lower LV and RV cardiac output at week 24 (p = 0.01 and p = 0.01). Four cases died during follow-up (3 due to cardiac complications, 1 due to renal crisis). The two who died from heart failure had very high NT-prohormone-brain natriuretic peptide (NT-proBNP) and impaired LV ejection fraction (LVEF), and the one who died from arrhythmia had very high sensitivity of cardiac Troponin-T (hs-cTnT).

Conclusions: Moderate-dose steroid therapy may improve myocarditis in SSc. A proportion of patients died due to cardiac complications during treatment, particularly those with high hs-cTnT, high NT-proBNP, and impaired LVEF. This trial is registered with NCT03607071.

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来源期刊
CiteScore
4.40
自引率
0.00%
发文量
9
审稿时长
24 weeks
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