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。

Etiologies and Clinical Characteristics of Polyserositis Patients With Pericardium Involvement

Objectives:To clarify the etiologies and clinical characteristics of polyserositis patients with pericardium involvement.Methods:The clinical data of 326 polyserositis patients with pericardium involvement,who admitted to Peking University People’s Hospital from January 2010 to December 2017,were retrospectively analyzed.Firstly,the etiologies of patients were determined,and then the differences in clinical characteristics were compared between malignant and nonmalignant patients according to whether the polyserositis was caused by malignant tumors or not.Results:Etiology was unknown in 78 out of 326 patients(23.9%).In patients with definite etiology,the common causes were autoimmune diseases(15.3%),malignant tumors(14.4%),cardiac insufficiency(11.3%),tuberculosis(8.0%)and hypoalbuminemia(5.2%),respectively.In patients with malignant tumors,the vast majority polyserositis(97.9%)was caused by metastasis of lung cancer,breast cancer and lymphoma.Compared with non-malignant patients(n=279),malignant patients(n=47)were mainly featured by acute onset,large amount of pericardial effusion and easily occur pericardial tamponade;the positive rate of blood laboratory examination was low,and the positive rate of CT or PET-CT was high.Pericardial effusion was mainly hemorrhagic,and the levels of total cell count,lactate dehydrogenase and multiple tumor markers were also significantly higher.In addition,positive rate of cytopathological examination,as the“gold standard”for the diagnosis of malignant pericardial effusion,was low in malignant patients.Conclusions:Autoimmune diseases,malignant tumors and cardiac insufficiency are the main etiologies of polyserositis patients with pericardium involvement.CT or PET-CT and laboratory examination of pericardial effusion play an important role in the differentiation of malignant and non-malignant effusion.