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。

Retrospective analysis of the etiological factors with large pericardial effusion

Objective By collecting and analyzing the influencing factors of the causes of 41 patients with large pericardial effusion, to provide more clear diagnosis and treatment ideas for the large pericardial effusion. Methods According to the criteria of diagnosis and treatment guide for pericardial diseases issued by European Society of Cardiology in 2015, 41 patients with large pericardial effusion admitted to Fujian Provincial Hospital and Fujian Provincial Jinshan Hospital from January 1, 2017 to October 1, 2019 were collected. According to the etiological diagnosis, all the patients were divided into four groups:tuberculous pericardial effusion group (TB group), malignant tumor pericardial effusion group (MT group), non TB infective pericardial effusion group (NTB group) and other etiology group (OE group). The influencing factors of pericardial effusion were analyzed by SPSS statistical software. Results The 41 cases of large pericardial effusion were included in this study, including 24 males and 17 females, with an average age of (60.3±14.9) years. TB group, MT group, NTB group and OE group accounted for 24.4%, 24.4%, 29.3% and 21.9% respectively. According to the definition of light standard, 97.6% of pericardium cases are exudates. The adenosine deaminase level of tuberculous pericardial effusion was the highest(57.0±37.3U/L), which was much higher than other groups(P<0.01). The area under ROC curve of adenosine deaminase in the diagnosis of tuberculous pericardial effusion was 0.961, and the best cut-off point was 20.5U/L, with a sensitivity of 100% and a specificity of 80.6%. Multiple logistic regression analysis showed that the main factors influencing the cause of large pericardial effusion were hemoglobin, adenosine deaminase and carcinoembryonic antigen in pericardial effusion. Conclusion The common causes of large pericardial effusion are tuberculosis and malignant tumor in this study. Adenosine deaminase is a sensitive index for the diagnosis of tuberculous pericardial effusion. Light standard is not helpful for the etiology diagnosis of large pericardial effusion. Hemoglobin, adenosine deaminase and carcinoembryonic antigen in pericardial effusion are important indexes for the etiology judgment of large pericardial effusion.