小剂量秋水仙碱治疗Takotsubo心肌病合并心包积液1例并文献复习

Low-dose colchicine for the treatment of Takotsubo cardiomyopathy with pericardial effusion:a case report and literature review

目的报道1例小剂量秋水仙碱治疗Takotsubo心肌病合并心包积液的病例。回顾既往文献报道,探讨Takotsubo心肌病合并心包积液和心包炎的可能机制及处理方法。病例介绍患者女性,54岁。父亲去世后突发胸痛,心电图显示胸前导联T波倒置,肌钙蛋白轻度升高,心脏超声造影和心脏磁共振显示心尖段运动幅度减低,基底段运动呈代偿样幅度增强,心包少至中量积液,冠状动脉造影未见异常,诊断为Takotsubo心肌病伴有心包积液。经治疗后患者心脏收缩功能恢复,但心包积液无好转,经小剂量秋水仙素口服治疗20 d后心包积液吸收。文献检索及分析检索PubMed、中国知网和万方数据库。检索的英文关键词包括:“colchicine”“Takotsubo cardiomyopathy”“stress cardiomyopathy”“pericardial effusion”及“pericarditis”,检索的中文关键词包括“秋水仙碱”“Takotsubo心肌病”“应激性心肌病”“心包积液”及“心包炎”。检索年限截至2023年5月30日,共检出符合标准的文献170篇,经进一步筛选标题及摘要获得关于Takotsubo心肌病病例报告及回顾性研究共21篇。结论Takotsubo心肌病合并心包积液的患者少见,推测Takotsubo心肌病相关的透壁炎症或心肌炎累及心包,导致心包炎和心包积液,文献个案报道合并大量心包积液需要心包穿刺,大部分患者使用非甾体抗炎药或秋水仙碱等治疗,心包积液可吸收。

Objective To report a case of low-dose colchicine in the treatment of Takotsubo cardiomyopathy with pericardial effusion,and review of previous literature reports on the mechanism and treatment of Takotsubo cardiomyopathy with pericardial effusion and pericarditis.Clinical Feature A 54-year-old female patient suffered from sudden chest pain after the death of her father.The patient underwent electrocardiogram(ECG),biochemical examination,left ventricular angiography,cardiac magnetic resonance,and cardiac acoustic contrast.The results revealed that the T wave in the precordial lead was inverted and the troponin level was slightly increased.Cardiac contrast echocardiography and cardiac magnetic resonance imaging showed that the motion amplitude of the apical segment was reduced,while the motion amplitude of the basal segment was compensated.The pericardium displayed mild-to-moderate effusion.Coronary angiography revealed no abnormalities.Takotsubo cardiomyopathy was conclusively diagnosed,along with the presence of a pericardial effusion.The patient′s cardiac systolic function recovered after treatment;however,the pericardial effusion did not diminish.After 20 days of oral treatment with a small dose of colchicine,the pericardial effusion was absorbed.Data Review We reviewed the literature from PubMed,CNKI,and WANFANG databases using the following keywords:“colchicine”“Takotsubo cardiomyopathy”“stress cardiomyopathy”“pericardial effusion”and“pericarditis”.A total of 170 publications were available until May 30,2023.Of these,21 were selected.Conclusions Takotsubo cardiomyopathy with pericardial effusion is rare.Takotsubo cardiomyopathy-related transmural inflammation or myocarditis is speculated to affect the pericardium,leading to pericarditis and subsequent pericardial effusion.The literature has reported that pericardial puncture is required for patients with a large number of pericardial effusions.Most patients are administered nonsteroidal anti-inflammatory drugs or colchicine,which leads to the absorption of pericardial effusion.