■非甾体免疫抑制疗法是心脏结节病的潜在治疗策略。然而,不建议将其作为既定的治疗选择。本研究旨在通过日本PATiEnts心脏结节病多中心回顾性注册的管理和预后说明,证明使用非甾体免疫抑制剂的心脏结节病患者的临床结局。
■来自512名患者的队列,纳入426名接受皮质类固醇治疗的患者和26名接受其他免疫抑制治疗的患者进行分析。临床结果包括全因死亡,致命的室性心律失常事件(FVAE),住院导致心力衰竭恶化。
■非甾体免疫抑制剂用于保留心脏中的氟脱氧葡萄糖摄取(n=14),皮质类固醇副作用(n=7),室性心律失常(n=4),完全性房室传导阻滞(n=2),心外结节病恶化(n=2),和其他原因(n=2)。它们由甲氨蝶呤(n=20)组成,环孢菌素(n=2),环磷酰胺(n=2),和硫唑嘌呤(n=3)。加入非甾体免疫抑制剂后,26例患者中有14例减少了皮质类固醇(5[5-17]mg),尽管没有患者停用皮质类固醇。在14名患者中,在随访中观察到7例氟脱氧葡萄糖摄取降低.在11例患者中观察到临床结果(42.3%)。检测到的事件包括5例患者的全因死亡(19.2%),四个FVAE(15.4%),5例住院心力衰竭恶化(19.2%),有一些重叠。
■非甾体类免疫抑制疗法可能是单独使用皮质类固醇或出现皮质类固醇副作用的患者的一种可能的治疗选择。
UNASSIGNED: Nonsteroidal immunosuppressive therapy is a potential therapeutic strategy for cardiac sarcoidosis. However, it is not recommended as an established treatment option. This study aimed to demonstrate the clinical outcomes of patients with cardiac sarcoidosis using nonsteroidal immunosuppressants through the ILLUstration of the Management and PrognosIs of JapaNese PATiEnts with Cardiac Sarcoidosis multicenter retrospective registry.
UNASSIGNED: From a cohort of 512 patients, 426 who received corticosteroid therapy and 26 who received other immunosuppressive therapy were included for analysis. Clinical outcomes included all-cause death, fatal ventricular arrhythmic events (FVAE), and worsening heart failure with hospitalization.
UNASSIGNED: Nonsteroidal immunosuppressants were used for retained fluorodeoxyglucose uptake in the heart (n = 14), corticosteroid side effects (n = 7), ventricular arrhythmia (n = 4), complete atrioventricular block (n = 2), worsened extracardiac sarcoidosis (n = 2), and other reasons (n = 2). They comprised of methotrexate (n = 20), cyclosporine (n = 2), cyclophosphamide (n = 2), and azathioprine (n = 3). After the addition of a nonsteroidal immunosuppressant, corticosteroids were reduced in 14 of 26 patients (5 [5-17] mg), although no patient discontinued corticosteroids. Of the 14 patients, decreased fluorodeoxyglucose uptake was observed in seven at follow-up. Clinical outcomes were observed in 11 patients (42.3 %). Detected events included all-cause death in five patients (19.2 %), FVAE in four (15.4 %), and worsening heart failure with hospitalization in five (19.2 %), with some overlap.
UNASSIGNED: Nonsteroidal immunosuppressive therapy may be a possible treatment option for patients who are not stabilized with corticosteroids alone or develop corticosteroid side effects.