72例心包积液病因及误诊分析

目的 分析72例心包积液病因及误诊原因。方法 回顾分析2000年1月-2006年3月诊断有心包积液的病例72例。结果 心包积液病因依次是肿瘤性（22．2％）；结核性（16．7％）；心力衰竭性（12．5％）；非特异性（11．1％）；甲状腺机能减退性（8．3％）；其他病因及诊断不明的占29．2％。结论 肿瘤性心包积液发病率最高，且肿瘤性心包积液误诊为结核性及非特异性最高。     

血性心包积液病因分析

目的探讨血性心包积液的病因分布特点。方法选自2002年1月至2012年7月北京军区总医院东区64例和2013年4月至2014年4月北京朝阳急诊抢救中心4例,行心包穿刺明确诊断为血性心包积液患者68例。其中男性28例,女性40例,年龄范围19~87岁。按年龄将患者分为2组,老年组33例(≥60岁)和中青年组35例(18~59岁)。按性别分男性组(28例)和女性组(40例)。收集所有患者临床资料,分析血性心包积液病因分布。结果患者常见病因为恶性肿瘤(55.9%)、结核(26.4%)及非特异性心包积液(7.4%)。其他病因分别为心力衰竭、主动脉夹层及先心病等。老年组与中青年组的常见病因分布比例比较,差异无统计学意义(P均0.05)。男性组和女性组血性心包积液的常见病因分别为肿瘤和结核,男性与女性病因分布比例比较,差异无统计学意义(P均0.05)。肿瘤致血性心包积液,肺肿瘤占60.5%,妇科肿瘤13.2%,消化道肿瘤10.5%,心包间皮瘤5.3%,肾及肾上腺肿瘤5.3%,皮肤及颈部淋巴瘤各2.6%。结论肿瘤和结核为血性心包积液的主要致病因素,与年龄和性别无明显相关。     

115例心包积液患者病因及误诊分析

目的分析115例心包积液患者的病因变化及误诊原因。方法收集我院1995～2004年收治的115例心包积液患者的临床资料并进行回顾性分析。结果心包积液常见病因依次为肿瘤性(19.1%)、结核性(18.3%)、非特异性(13.9%)、心力衰竭性(12.2%)、尿毒症性(6.1%)和结缔组织疾病(5.2%),其他各种原因引起者占14.8%,肿瘤已成为心包积液的首要病因。误诊8例。结论肿瘤是心包积液的首要病因。误诊的主要原因是将肿瘤性心包积液诊断为其他性质的心包积液。     

心电图初步诊断恶性心包积液的临床价值

目的：探讨心电图在恶性心包积液初步诊断中的临床价值。方法回顾性观察149例恶性肿瘤患者心包积液的病因分布,并分析其心电图改变情况。结果恶性肿瘤合并心包积液患者以肺癌、乳腺癌及恶性淋巴瘤占多数。恶性心包积液患者窦性心动过速、胸／全导联低电压及 ST-T 改变的检出率显著高于良性心包积液患者,且差异有统计学意义（P ＜0．01）。结论当原发肿瘤患者出现上述心电图改变时,应高度怀疑合并恶性心包积液,可结合心脏彩超或 CT 等其他影像学资料进一步诊断。     

心包积液原因待查的病因分析(附80例病例报告)

目的 回顾性分析以心包积液为首发和/或为主要临床表现的病例,了解其病因构成。方法 分析总结北京协和医院(PUMC hospital)10年来以心包积液待查入院诊断的病例80例。结果 获得明确诊断的病例有63例(78.75％),结核性占首位(43.75％),肿瘤居第二(16.2％),不明原因17例(21.25％)。治愈6例(7.5％),好转61例(76.25％),死亡5例(6.25％),无变化8例(10％)。结论 以原因不明心包积液就诊者,结核仍占首位,此类疾病在诊断特发性心包炎之前需进一步除外恶性肿瘤及甲状腺功能减退。     

大量心包积液病因影响因素的回顾性分析

目的 收集并分析41例大量心包积液患者病因的影响因素，为诊治大量心包积液提供更为清晰诊疗思路。方法 根据2015年欧洲心血管病学会《心包疾病的诊断和治疗指南》诊断大量心包积液的标准，收集2017.1.1-2019.10.1期间入住福建省立医院及福建省立金山医院的大量心包积液患者41例，根据其病因诊断将所有入组对象分为4组：结核性心包积液组（TB组）、恶性肿瘤性心包积液组（MT组）、非TB感染性心包积液组（NTB组）及其他病因心包积液组（OE组）。采用SPSS统计软件分析所有入组患者心包积液患者病因的影响因素。结果 41例大量心包积液患者中男性24人，女性17人，平均年龄为60.3±14.9岁。TB组、MT组、NTB组及OE组患者分别占24.4%，24.4%，29.3%，21.9%。按照Light标准的定义，大量心包积病例中97.6%为渗出液。结核性心包积液的腺苷脱氨酶水平最高，达57.0±37.3U/L，远高于其他病因所致的心包积液（P<0.01）。腺苷脱氨酶诊断结核性心包积液的ROC曲线下面积0.961，最佳诊断切点为20.5U/L，此时敏感性达100%，特异性达80.6%。多元Logistics回归分析显示大量心包积液病因的主要影响因素有血红蛋白、心包积液腺苷脱氨酶水平和心包积液癌胚抗原水平。结论 本研究发现大量心包积液最常见病因是结核和恶性肿瘤，腺苷脱氨酶是诊断结核性心包积液的敏感指标，Light标准无法鉴别大量心包积液的病因，血红蛋白、心包积液腺苷脱氨酶和心包积液癌胚抗原是影响大量心包积液病因判定的重要指标，具有一定临床指导意义。     

96例右中叶综合征病因分析

目的探讨右中叶综合征的病因分布规律。方法分析96例临床诊断右中叶综合征患者的病因，并按年龄分组进行比较。结果病因组成炎症占66．7％，肿瘤占17．7％，结核占9．4％。炎症在青年组和中年组间有显著差异（P均〈0．05）；肿瘤及结核在青年组和中年组间、青年组和老年组间均有显著差异（P均〈0．05）。结论右中叶综合征最常见的病因依次为炎症、肿瘤和结核，埘于年龄〉40岁的患者应高度警惕罹患癌症的可能。     

135例胸腔积液患者内科胸腔镜检查及临床意义

目的探讨内科胸腔镜检查对不明原因胸腔积液患者的临床意义。方法分析内科胸腔镜检查135例患者的临床资料。结果135例中,经胸腔镜胸膜活检确诊104例（77．0％）,其中病理为恶性肿瘤和结核性胸膜炎各51例（49．0％）,脓胸2例（1．9％）。135例胸腔积液患者经胸腔镜检查病因诊断阳性率85．9％。恶性肿瘤和结核性胸膜炎患者经胸腔镜胸膜活检阳性率分别为79．7％和91．1％。结论内科胸腔镜检查对不明原因胸腔积液患者有获得病理诊断、病因诊断及准确肺癌分期等临床意义。     

急慢性心包炎首次心电图误判因素分析

心包疾病约占心血管病住院患者的1．5％～6％，它常是某种疾病的部分表现或并发症，可被原发疾病的临床症状所掩盖。病因很多，既往常见的如风湿热、细菌感染和结核已明显减少，而病毒感染、肿瘤有所增多。各种心包病变的诊断，在临床上一般并不困难。但是，缩窄性心包炎的患者、肿瘤晚期转移引起的心包炎，尤其近十几年来的缺血性心脏病     

胸腔积液386例临床分析

目的探讨胸腔积液的病因分布及诊治特点。方法回顾性分析386例胸腔积液的临床资料。结果通过典型临床表现、影像学检查、胸液及血清学实验室检查、胸膜活检或通过临床治疗明显好转、随诊1—3个月后确诊良性胸液244例，其中结核性175例（71．7％），肺炎26例（10．7％），肺梗塞16例（6．6％），心功能不全11例（4．5％），其他16例。恶性138例，其中原发性肺癌99例，乳腺癌11例，淋巴瘤8例，其他20例。不明原因者4例。结论结核和肿瘤是导致胸腔积液的主要原因，能否尽快鉴别二者直接影响其治疗和预后。     

Bloody pericardial effusion in patients with cardiac tamponade: is the cause cancerous, tuberculous, or iatrogenic in the 1990s?

STUDY OBJECTIVES: The decrease in incidence of tuberculosis, along with the increase in invasive cardiovascular procedures, may have changed the frequency of causes of bloody pericardial effusion associated with cardiac tamponade, although this is not yet recognized by medical textbooks. We analyzed the causes of bloody pericardial effusion in the clinical setting of cardiac tamponade in the 1990s; patients' survival; the effect of laboratory results on discharge diagnosis; and how often bloody pericardial effusion is a presenting manifestation of a new malignancy or tuberculosis. DESIGN: Retrospective, observational, single-center study. SETTING: A community hospital. PATIENTS: The charts of all patients who underwent pericardiocentesis for cardiac tamponade and had bloody pericardial effusion were retrospectively reviewed. RESULTS: Of 150 patients who had pericardiocentesis for relieving cardiac tamponade, 96 patients (64%) had a bloody pericardial effusion. The most common cause of bloody pericardial effusion was iatrogenic disease (31%), namely, secondary to invasive cardiac procedures. The other common causes were malignancy (26%), complications of atherosclerotic heart disease (11%), and idiopathic disease (10%). Tuberculosis was detected as a cause of bloody pericardial effusion in one patient and presumed to be the cause in another patient. Bloody pericardial effusion was found to be a presenting manifestation of a newly diagnosed malignancy in two patients. The patients in the idiopathic and iatrogenic groups were all alive and had no recurrence of pericardial effusion at 24 +/- 27 and 33 +/- 21 months after hospital discharge, respectively, whereas 80% of patients with malignancy-related bloody effusions died within 8 +/- 6 months. CONCLUSIONS: In a patient population that is reasonably representative of that in most community hospitals in the United States, the most common cause of bloody pericardial effusion in patients with signs or symptoms of cardiac tamponade is now iatrogenic disease. Of the noniatrogenic causes, malignancy, complications of acute myocardial infarction, and idiopathic disease predominated. Hemorrhagic tuberculous pericardial effusions are uncommon and may likely reflect a low incidence of cardiac tuberculosis in community hospitals in the United States.     

Etiology and prognostic implications of a large pericardial effusion in men

To assess the etiology and prognosis of a large pericardial effusion, we reviewed 25 consecutive patients who presented with a large pericardial effusion and underwent a drainage procedure. Large pericardial effusion was defined as: (1) an echo-free space greater than or equal to 10 mm anteriorly and posteriorly by M-mode echocardiography and (2) removal of greater than or equal to 350 ml of fluid at pericardial drainage. The etiologies of large pericardial effusion were: neoplastic (36%), idiopathic (32%), uremic (20%), postmyocardial infarction (8%), and acute rheumatic fever (4%). Of our patients, 44% presented with cardiac tamponade, while 25% of patients with idiopathic pericarditis had hemorrhage effusion and cardiac tamponade. At follow-up, 37 +/- 17 months after pericardial drainage, 68% had died from complications of their underlying disease. There were no deaths attributed to pericardial disease. While 88% of patients with idiopathic large pericardial effusion were alive at follow-up, none of the neoplastic large pericardial effusion patients survived longer than 5 months after initial pericardial drainage (p less than 0.001). Additionally, the survival of patients with uremic large pericardial effusion was better than patients with neoplastic large pericardial effusion (p less than 0.05). We conclude: (1) neoplastic, idiopathic, and uremic pericarditis are the most common causes of large pericardial effusion in men, (2) idiopathic pericarditis can be hemorrhagic and cause cardiac tamponade, and (3) the prognosis of large pericardial effusion is related to patients' underlying disease.     

Pericardial tamponade and large pericardial effusions: causal factors and efficacy of percutaneous catheter drainage in 50 patients

In 50 patients treated from January 1998 through March 2002 for pericardial effusion and tamponade, we retrospectively investigated the efficacy of percutaneous placement of an indwelling pericardial catheter guided by 2-dimensional echocardiography and fluoroscopy. We also investigated causation. In 80% of the patients, we were able to determine specific causes through clinical, serologic, and cytologic investigation: cancer in 15 patients, chronic renal failure in 11, systemic lupus erythematosus in 2 rheumatoid arthritis in 2, Dressler syndrome in 2, tuberculosis in 1, blunt chest trauma in 1, purulent pericarditis in 1, and probably viral pericarditis in 5. No specific cause could be determined in 10 patients (20%). We did not observe any complication due to the procedure. Two patients died during hospitalization. After hospitalization, 9 patients with metastatic cancer died within 3 months. A 2nd percutaneous drainage procedure was required in 2 cancer patients. Recurrence of pericardial effusion and tamponade and the requirement of pericardiectomy occurred in 2 patients with perfusion of unknown cause and in 1 patient with perfusion due to rheumatoid arthritis. Histologic examination of pericardial tissue in patients with idiopathic disease showed fibrinous pericarditis but no causal factor. In the group with idiopathic pericardial effusion, 2 patients with multiple mediastinal lymphadenopathy underwent mediastinal exploration; biopsy revealed nonspecific lymphadenitis and fibrinous pericarditis. In patients with large pericardial effusions and tamponade, the specific cause was in most cases already known or obtained by initial clinical and laboratory investigation. Sufficient cardiac decompression was achieved by percutaneous pigtail catheter drainage.     

以心包积液为主多浆膜腔积液患者的病因学分布和临床特征分析

目的:明确以心包积液为主多浆膜腔积液患者的病因学分布以及恶性积液和非恶性积液患者临床特征的差异。方法:回顾性分析2010年1月至2017年12月于北京大学人民医院住院治疗的326例以心包积液为主多浆膜腔积液患者的临床资料,明确病因分布情况;并根据多浆膜腔积液是否为恶性肿瘤所致,分为恶性积液组和非恶性积液组,分析两组患者临床特征差异。结果:(1)病因学分布:326例患者中78例(23.9%)病因不明;在病因明确患者中,常见原因依次为自身免疫性疾病(n=50,15.3%)、恶性肿瘤(n=47,14.4%)、心功能不全(n=37,11.3%)、结核(n=26,8.0%)和低白蛋白血症(n=17,5.2%)。在恶性肿瘤所致患者中,97.9%(46/47)为其他部位恶性肿瘤(肺癌、乳腺癌和淋巴瘤)转移所致。(2)临床特征差异:与非恶性积液组患者(n=279)相比,恶性积液组患者(n=47)主要以急性起病、大量心包积液和易发生心包填塞为主;血液实验室检查阳性率低,CT或正电子发射型计算机断层扫描显像(PET-CT)检查阳性率高;心包积液以血性为主,细胞总数、乳酸脱氢酶和多个肿瘤标志物水平明显升高,但Light标准在鉴别恶性和非恶性积液中无明显作用;此外,细胞病理检查作为诊断恶性积液的“金标准”,阳性率低。结论:自身免疫性疾病、恶性肿瘤和心功能不全是以心包积液为主多浆膜腔积液患者的主要病因。恶性积液患者起病急、病情重且易恶化,CT或PET-CT以及心包积液实验室检查在恶性与非恶性积液的鉴别中具有重要作用。     

Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature

BACKGROUND: Human immunodeficiency virus (HIV)-associated pericardial effusion is common. We present its clinical features, cause, and prognosis on the basis of a review of 40 cases at a single public hospital. METHODS: A retrospective study was conducted of 122 patients with pericardial effusion (of which 40 were HIV associated) admitted to Queens Hospital Center from January 1988 to April 1997. A review of the literature is also presented. RESULTS: Forty patients with HIV-associated pericardial effusion represent 33% of the 122 patients with pericardial effusion admitted during that period. The most common symptom of the 40 patients was dyspnea (75%). Echocardiogram detected small effusions in 18 (45%), moderate effusions in 10 (25%), and large effusions in 12 (30%). Sixteen (40%) patients had cardiac tamponade, in 15 of whom pericardiocentesis or pericardiostomy was performed. Causes of cardiac tamponade were Mycobacterium species in 3 (19%), Streptococcus pneumoniae in 1 (6%), Staphylococcus aureus in 1 (6%), Kaposi's sarcoma in 1 (6%), and unknown in 10 (63%). In comparison, causes of cardiac tamponade in 74 cases of acquired immunodeficiency syndrome in the literature were 45% idiopathic, 20% mycobacteria, 19% bacteria, 7% lymphoma, 5% Kaposi's sarcoma, 3% viruses, and 1% fungus. Thirteen of the 40 patients were lost to follow-up. Among the other 27, 11 (41%) were alive at 3 months and 5 (19%) at 1 year. Ten of the 27 patients had cardiac tamponade, of whom 5 (50%) were alive at 3 months and 3 (30%) at 1 year. CONCLUSIONS: HIV-associated pericardial effusion is the most common type of pericardial effusion in our inner city hospital. Causes are diverse. The development of pericardial effusion predicts a poor prognosis in HIV infection.     

Pericardial effusions in patients with end-stage renal disease

Echocardiography has greatly increased the accurate recognition of pericardial effusion. Echocardiograms were performed prospectively on the total group of 35 stable asymptomatic patients on chronic haemodialysis to determine the incidence of pericardial effusion. Effusions were shown in 11 per cent (4/35); only 6 per cent (2/35) were estimated as greater than 100 ml. For comparison, records were reviewed retrospectively from 41 haemodialysis patients referred during a 27-month period for echocardiographic assessment of suspected pericardial effusion. These 41 patients came from a total group of 108 patients treated with chronic dialysis over this interval. Of 41 examined, 21 (51%) or 21 of 108 (19%) of the population at risk had an effusion. Of 21 with echocardiographic effusions, 15 (71%), or 15 of 41 (37%) of those with clinically suspected effusion, had more than 100 ml fluid. Gross (greater than 100 ml) pericardial effusions are infrequent in stable, asymptomatic patients with end-stage renal disease. When clinical findings suggest pericardial disease, the echocardiographic demonstration of over 100 ml pericardial fluid is indicative of new effusion, rather than coincidental pre-existing effusion.     

Pericardial effusions in patients with end-stage renal disease.

Echocardiography has greatly increased the accurate recognition of pericardial effusion. Echocardiograms were performed prospectively on the total group of 35 stable asymptomatic patients on chronic haemodialysis to determine the incidence of pericardial effusion. Effusions were shown in 11 per cent (4/35); only 6 per cent (2/35) were estimated as greater than 100 ml. For comparison, records were reviewed retrospectively from 41 haemodialysis patients referred during a 27-month period for echocardiographic assessment of suspected pericardial effusion. These 41 patients came from a total group of 108 patients treated with chronic dialysis over this interval. Of 41 examined, 21 (51%) or 21 of 108 (19%) of the population at risk had an effusion. Of 21 with echocardiographic effusions, 15 (71%), or 15 of 41 (37%) of those with clinically suspected effusion, had more than 100 ml fluid. Gross (greater than 100 ml) pericardial effusions are infrequent in stable, asymptomatic patients with end-stage renal disease. When clinical findings suggest pericardial disease, the echocardiographic demonstration of over 100 ml pericardial fluid is indicative of new effusion, rather than coincidental pre-existing effusion.