结核性心包炎22例临床分析

结核性心包炎在临床并不少见,但在早期症状不典型常被忽略,一经确诊多为病人症状较重且有明显心包积液。现就我院收治的22例结核性心包炎做一临床分析,就有关问题进行探讨。1 临床资料l.1 一般资料:本组共22例,根据有结核中毒症;有心包积液(经X线及B超证实):血沉增快(14例占63％);经抗痨治疗明显吸收好转者为诊断依据。男17     

28例结核性缩窄性心包炎临床诊疗分析

目的 通过分析结核性缩窄性心包炎（CTP）的临床特点、治疗与转归，以期提高CTP的诊疗水平。方法 对手术后病理证实为CTP的28例病人临床资料进行分析与总结。结果 CTP主要症状为气促、心悸、胸闷及腹胀，体征主要为颈静脉怒张与下肢水肿；多合并心包外结核病：心脏超声及CT检查均示心包膜增厚伴有钙化；手术后症状及心功能均有缓解而全部出院。术后随访4-24个月无需二次手术。结论 CTP临床症状无特异性，心包外结核病是CTP初步诊断依据；心脏超声和胸部cT是判断结核性心包炎是否已发生缩窄的可靠指标；手术是解除CTP心脏机械性压迫有效而又比较安全的治疗手段；加强围手术期的治疗是降低手术风险的关键。     

结核性心包炎49例临床分析

结核性心包炎临床上并不少见 ,如延误诊断 ,治疗不合理 ,预后远较其他浆膜结核病差 ,死亡率也高。现将我院 195 9～1998年确诊的结核性心包炎 4 9例 ,就其临床特点进行探讨。1　临床资料1.1　一般资料 :本组 4 9例结核性心包炎 ,男 2 7例 ,女 2 2例 ,占同期结核病 ( 4 9/3 5 80 9) 0 .1% ,年龄 16～ 81岁 ,平均年龄 4 6.8岁 ,<3 5岁 18例 ( 3 6.7% ) ,>60岁 16例 ( 3 2 .6% )。1.2　诊断标准[1 ,2 ,3] :1合并活动性结核病变或有结核病史 2典型临床症状体征 3 X线或超声心动图显示心包积液 4 PPD强阳性者 5抗结核治疗有效 6除外其他病因的…     

以心包缩窄及占位性病变为表现的结核性心包炎一例

结核性心包炎并非临床疑难疾患,但近年因结核症状趋于不典型,结核病发病率增高而人们重视程度不够,以至于临床经常误诊、延误病情。现报告以心包缩窄、占位性病变为主要表现的结核性心包炎1例。患者男性,5 1岁,主因活动后心悸、气促伴咳嗽1年,加重10d ,于2 0 0 3年3月2 7日入院。无发热、盗汗,体重无减轻。在当地医院进行超声心动图、胸片、计算机体层摄影术(CT)、核磁共振等检查,诊断为缩窄性心包炎、心包肿瘤待除外。查体:体温36 4℃,血压14 0 / 110mmHg(1mmHg =0 133kPa)。颈静脉充盈明显,双肺呼吸音清,无干、湿性音。心界不大,心…     

结核性心包炎的临床治疗研究

目的分析研究结核性心包炎采用临床治疗的临床治疗效果。方法抽取近年来在我院收治的患有结核性心包炎的病人120例,采用随机抽取模式,随机分为实验组和对照组,每组各60例。对照组对病人实施常规临床西医治疗模式,实验组在对照组治疗的基础之上加入置入中心静脉导管联合心包当中注入尿激酶进行治疗,对两组临床治疗效果进行对比分析。结果实验组病人住院天数、临床症状好转时间以及积液消失时间明显优于对照组,两组间差异具有统计学意义(P0.05);实验组临床治疗效果明显优于对照组,两组间差异具有统计学意义(P0.05)。结论对结核性心包炎采用置入中心静脉导管联合尿激酶共同治疗,可以获得明显的临床治疗效果,使发生并发症的几率明显减少,使病人健康生活质量得到保障,具有临床推广价值。     

心包厚度正常的26例缩窄性心包炎

增厚的心包通常被认为是缩窄性心包炎的基本诊断特征。有研究显示正常厚度的心包也存在缩窄性,然而与之相关的临床病理特征却并不明了。该文的作者通过回顾性研究来探讨因缩窄而行心包切除术的心包厚度正常患者的临床和病理特征。方法和结果:1 993年至1 999年在Mayo诊所共有1 4     

结核性心包炎合并心包结核瘤一例

<正>结核性心包炎是发展中国家心包疾病的主要病因,也是重症结核病之一,占心包疾病的40%～66%[1],在欧洲和北美占所有心包疾病的比例低于5%[2]。高达30%的患者可进展为缩窄性心包炎,且多见于青年男性[3],但国内外罕见有伴发巨大心包结核瘤的报道。青岛市胸科医院收治了1例结核性心包炎患儿,诊疗过程中出现前纵隔占位曾疑诊为胸腺瘤,最终术后确诊为结核性心包炎伴发心包结核瘤。现将诊治过程报道如下,以供临床参考。     

心包厚度正常的26例缩窄性心包炎

心包增厚是缩窄性心包炎的基本诊断依据。有研究表明正常厚度的心包也存在缩窄性，该文通过回顾性研究来探讨因缩窄而行心包切除术的心包厚度正常患者的临床和病理特征。     

Constrictive pericarditis: Its history and current status

The diagnosis of constrictive pericarditis remains a challenge because it is often mimicked by restrictive cardiomyopathy. The last few years have seen numerous advances in our ability to differentiate between these two conditions which often have similar physical findings and hemodynamics. This review begins with a brief history of constrictive pericarditis; this is followed by an extensive discussion of newer etiologies, and then the classical clinical history and physical examination findings are described. Radiologic, electrocardiographic, and angiographic findings are discussed. The hemodynamics of constrictive pericarditis are reviewed. Recent results of echocardiographic and echo-Doppler investigations are presented. Emphasis is placed upon the limitations of M-mode echocardiography in the diagnosis of constrictive pericarditis. The value of echocardiographic Doppler studies of mitral and tricuspid flow velocity patterns, as well as of those in the pulmonary veins and hepatic veins, is described. Nuclear ventriculograms and angiocardiograms tend to show more rapid ventricular filling in constrictive pericarditis than in restrictive cardiomyopathy. Although only a small number of patients has been studied, these evaluations seem to have merit in separating restrictive cardiomyopathy from constrictive pericarditis. The role of computed tomography scanning and magnetic resonance imaging studies of pericardial thickness in confirming the presence of constrictive pericarditis is discussed. Abnormal pericardial thickening (> 3 mm) confirms the diagnosis of constrictive pericarditis, but only if the characteristic hemodynamic pattern is present. The usefulness of endomyocardial biopsy in recognizing specific varieties of restrictive cardiomyopathy is presented. The topic of occult constrictive pericardial disease is discussed briefly. A discussion of the timing of pericardial resection for the treatment of constrictive pericarditis ends the review.     

Constrictive pericarditis localized to left ventricle presented with left pleural effusion: a case report

An 18-year old woman presented with progressive dyspnea and cough. Physical examination revealed decreased breath sounds at the left hemithorax and distant heart sounds with no murmurs or rub. Electrocardiogram revealed low voltage. Chest X-ray showed unilateral left-sided pleural effusion with no cardiomegaly. Transthoracic echocardiogram showed thickened pericardium localized throughout the left ventricle impairing the diastolic filling. Doppler waveforms were suggestive of localized constrictive pericarditis. A computerized tomographic scan of the chest confirmed the presence of unilateral pleural effusion with thickened pericardium surrounding the left ventricle. The patient's symptoms and signs were related to localized constrictive pericarditis and improved following surgery.     

Natriuretic peptides to differentiate constrictive pericarditis and restrictive cardiomyopathy: A systematic review and meta‐analysis

Previous studies have shown that natriuretic peptide levels are increased in patients with restrictive cardiomyopathy (RCM) but not in constrictive pericarditis (CP). We performed a systematic review and meta‐analysis to evaluate the diagnostic utility of B‐type natriuretic peptide (BNP) and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) to differentiate CP and RCM. We searched electronic databases from inception to January 07, 2021. Studies involving adult patients that assessed the utility of natriuretic peptides to differentiate CP and RCM were included. All meta‐analyses were performed using a random‐effects model. Seven studies (four case‐control and three cohorts) involving 204 patients were included. The mean age ranged between 25.7 and 64.1 years and 77% of patients were men. BNP levels were significantly lower (standardized median difference [SMD], −1.48; 95% confidence interval [CI], −2.33 to −0.63) in patients with CP compared to RCM. The pooled area under the curve (AUC) of the BNP level was 0.81 (95% CI, 0.70–0.92). NT‐proBNP (SMD, −0.86; 95% CI, −1.38 to −0.33) and log NT‐proBNP (SMD, −1.89; 95% CI, −2.59 to −1.20) levels were significantly lower in patients with CP compared to RCM. Our review shows that BNP and NT‐proBNP levels were significantly lower in patients with CP compared to RCM. The pooled AUC of BNP level showed a good diagnostic accuracy to differentiate both conditions.     

Multimodality approach to the diagnosis and management of constrictive pericarditis

Despite advances in cardiovascular imaging, the diagnosis of constrictive pericarditis remains challenging. A multimodality approach to the diagnosis of CP is essential to (a) fully assess the extent of pericardial thickening and calcification, (b) detect the functional and hemodynamic consequences of the constricting pericardium, and (c) implement the optimal management strategy in these often complex cases. This case-based review highlights the role and diagnostic ambiguities of multimodality imaging.     

缩窄性心包炎2例报告

1病历资料例1.女,49岁。主因双下肢水肿7个月,加重伴有劳力性气短5个月入院。既往慢性喘息性支气管炎20年,吸烟十余年(30支/d)。7个月前患者偶然发现右下肢小腿轻度凹陷性水肿,2个月后水肿进行性加重,从脚面、小腿、大腿一直延伸到腹壁,患者爬楼梯时感双下肢沉重,伴有气     

心肌内膜纤维化与缩窄性心包炎的心电图比较研究

比较17例心肌内膜纤维化(EMF)和82例缩窄性心包炎(CP)患者的心电图表现,结果发现EMF 患者心房扑动或颤动、右心房肥大、左心房肥大和右束支传导阻滞的发生率较 CP 患者高(分别为41%与4%,P<0.01;24%与5%,P<0.05;18%与2%,P<0.05和18%与1%,P<0.05)。而窦性心动过速的发生率则 CP 患者较 EMF 患者高(60%比12%,P<0.01)。低电压、ST 段下移、T 波低平或倒置和房性或室性早搏的发生率两者无显著性差异。     

Diagnosis of constrictive pericarditis obscured by hypertrophic cardiomyopathy: Back to basics

In this report, we describe the case of a 41‐year‐old man with hypertrophic cardiomyopathy presenting with right‐sided congestive heart failure symptoms. Noninvasive testing was suggestive, but non‐diagnostic for constrictive pericarditis (CP) and thus invasive hemodynamic catheterization was performed. The unique presence of both hypertrophic cardiomyopathy and constriction in this case led to lack of “modern” echocardiographic and invasive criteria for CP, based upon findings of enhanced ventricular dependence. However, classic hemodynamic criteria of early rapid filling with elevation and end‐equalization of diastolic pressures were present, and the patient ultimately received pericardiectomy with dramatic clinical improvement. © 2015 Wiley Periodicals, Inc.     

The prevalence and outcome of effusive constrictive pericarditis: a systematic review of the literature

Abstract

There is sparse information on the epidemiology of effusive constrictive pericarditis (ECP). The objective of this article was to review and summarise the literature on the prevalence and outcome of ECP, and identify gaps for further research. The prevalence of ECP ranged from 2.4 to 14.8%, with a weighted average of 4.5% [95% confidence interval (CI) 2.2–7.5%]. Sixty-five per cent (95% CI: 43–82%) of patients required pericardiectomy regardless of the aetiology. The combined death rate across the studies was 22% (95% CI: 4–50%). The prevalence of ECP is low in non-tuberculous pericarditis, while pericardiectomy rates are high and mortality is variable. In this review, of 10 patients identified with tuberculous ECP, only one presumed case had a definite diagnosis of ECP. Appropriate studies are needed to determine the epidemiology of ECP in tuberculous pericarditis, which is one of the leading causes of pericardial disease in the world.     

自身免疫性肝炎患儿临床特点与预后

目的了解自身免疫性肝炎(AIH)患儿临床特点与预后。方法回顾性分析2016年8月至2019年8月于湖北省襄阳市中心医院收治的138例AIH患儿的临床资料,分析临床特征及治疗、预后。结果138例患儿中AIH-1型96例(69.57%),AIH-2型42例(30.43%)。发热6例(4.35%),恶心、乏力12例(8.70%),转氨酶异常39例(28.26%),黄疸81例(58.70%)。AIH-1型患儿合并炎症性肠病、原发性硬化性胆管炎、系统性红斑狼疮、原发性胆汁性胆管炎分别为6例(4.35%)、9例(6.52%)、3例(2.17%)、3例(2.17%)。入院时所有患儿均有肝功能异常,AIH-1型者γ球蛋白、免疫球蛋白G显著高于AIH-2型者(P<0.05)。117例行肝活组织检查,提示界面性肝炎108例(92.31%),玫瑰花结9例(7.69%),浆细胞或淋巴细胞浸润69例(58.97%);肝脏炎症分级G≥3级66例(56.41%),纤维化分期S≥3级78例(66.67%)。120例行糖皮质激素规范治疗,完全缓解87例(72.50%),部分缓解30例(25.00%),无应答3例(2.50%)。完全缓解后激素减量期45例(51.72%)复发。结论儿童AIH多见于AIH-1型,临床表现复杂,发病时多数患儿肝脏炎症及纤维化已明显进展,激素单用或联合硫唑嘌呤治疗后可改善患儿生化指标及病理,但易复发。     

Severe constrictive pericarditis as an unsuspected cause of death in a patient with idiopathic hypereosinophilic syndrome and restrictive cardiomyopathy

A 43-year-old man with idiopathic hypereosinophilic syndrome survived a relatively long term (6 1/2 years) before he succumbed to intractable heart failure. Six months before death, his chronic heart failure from restrictive cardiomyopathy was well compensated. Autopsy demonstrated severe constrictive pericarditis which was not suspected antemortem. Constrictive pericarditis as a late complication of idiopathic hypereosinophilic syndrome is discussed.