Trautner B W, Darouiche R O
Department of Medicine, Infectious Disease Section, Houston Veterans Affairs Medical Center, and Baylor College of Medicine, Houston, TX 77030, USA.
Clin Infect Dis. 2001 Oct 1;33(7):954-61. doi: 10.1086/322621. Epub 2001 Aug 22.
Pericarditis is a rare manifestation of tuberculous disease. The appropriate diagnostic workup and optimal therapeutic management are not well defined. We present 10 new cases of tuberculous pericarditis and review the relevant literature. The specific topics addressed are (1) the importance of tissue for diagnosis, (2) the optimal surgical management, (3) the role of corticosteroids, and (4) the impact of human immunodeficiency virus (HIV) on the management of this disease. The cases and the literature suggest that the optimal management includes an open pericardial window with biopsy, both for diagnosis and to prevent reaccumulation of fluid. Corticosteroids probably offer some benefit in preventing fluid reaccumulation as well. The data are inconclusive regarding whether open drainage or corticosteroid use prevents progression to constrictive pericarditis. No studies have addressed these issues specifically in HIV-positive patients, but the 3 HIV-positive patients in our series had an excellent response to drainage and antituberculous therapy.
心包炎是结核病的一种罕见表现。目前对于合适的诊断检查方法和最佳治疗方案尚无明确界定。我们报告了10例结核性心包炎新病例，并对相关文献进行了综述。所涉及的具体主题包括：（1）组织检查对诊断的重要性；（2）最佳手术治疗方法；（3）皮质类固醇的作用；（4）人类免疫缺陷病毒（HIV）对本病治疗的影响。这些病例及文献表明，最佳治疗方案包括进行心包开窗活检术，这既有助于诊断，又能防止液体再次积聚。皮质类固醇在预防液体再次积聚方面可能也有一定益处。关于开放引流或使用皮质类固醇能否预防发展为缩窄性心包炎，现有数据尚无定论。尚无研究专门针对HIV阳性患者探讨这些问题，但我们系列中的3例HIV阳性患者对引流和抗结核治疗反应良好。
