Riccabona M, Rossipal E
Abteilung für Kinderradiologie, Universitäts-Klinikum LKH Graz, Osterreich.
Wien Klin Wochenschr. 2000 Jan 14;112(1):27-31.
Ultrasound revealed evidence of pericardial effusion in 13 out of 26 children with coeliac disease. In a prospective study, we tried to analyse the causes underlying this high incidence of pericardial effusion.
Twenty-six patients were evaluated. Coeliac disease was diagnosed by intestinal biopsy. All children underwent sonography and a laboratory work-up including endomysial antibodies and serum selenium and iron concentrations.
Patients with pericardial fluid showed no difference compared to those without effusion in regard to ECG, chest x-ray, red and white blood cell count, serum enzymes, serum protein as well as iron levels. The mean value of serum selenium was lower and endomysial antibody titre was higher in patients with pericardial effusion. However, due to the wide range, a clear distinction between the two groups was impossible. In all other investigated parameters there was no difference between patients with and without pericardial effusion. Patients with effusion had a higher frequency of viral infection.
The high incidence of pericardial effusion in patients with coeliac disease appears to be governed by a multifactorial mechanism. A high endomysial antibody titre as well as selenium deficiency may play a role as a predisposing factor. Viral infection due to reduced immunological competence in conjunction with a hampered ability to eliminate toxic free radicals might cause blood vessel dysfunction, resulting in (asymptomatic) pericardial effusion. The fact that most of these patients were diagnosed during the cold season, with anamnestic evidence of viral infection shortly before the diagnosis, and the fact that adult patients with dilative cardiomypathy show a greater prevalence of coeliac disease, supports the view that coeliac disease is systemic in nature.
超声检查发现26例乳糜泻患儿中有13例存在心包积液迹象。在一项前瞻性研究中，我们试图分析心包积液高发病率的潜在原因。
对26例患者进行了评估。通过肠道活检诊断乳糜泻。所有儿童均接受了超声检查以及包括肌内膜抗体、血清硒和铁浓度在内的实验室检查。
心包积液患者与无积液患者在心电图、胸部X线、红细胞和白细胞计数、血清酶、血清蛋白以及铁水平方面无差异。心包积液患者的血清硒平均值较低，肌内膜抗体滴度较高。然而，由于范围较宽，两组之间无法进行明确区分。在所有其他研究参数方面，有心包积液和无心包积液的患者之间没有差异。有积液的患者病毒感染频率较高。
乳糜泻患者心包积液的高发病率似乎由多因素机制所致。高肌内膜抗体滴度以及硒缺乏可能作为易感因素发挥作用。由于免疫能力下降以及清除有毒自由基的能力受阻导致的病毒感染，可能会引起血管功能障碍，从而导致（无症状的）心包积液。这些患者大多数在寒冷季节被诊断出来，且在诊断前不久有病毒感染的既往史，以及扩张型心肌病成年患者中乳糜泻患病率更高这一事实，支持了乳糜泻本质上是全身性疾病的观点。
