Cherian G, Uthaman B, Habashy A G, Salama A L, George S
Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait.
J Assoc Physicians India. 2003 Sep;51:880-3.
Tuberculosis is a common cause of pericardial effusion in many parts of the world often presenting with tamponade. Its recognition is important but not always easy. This study was to prospectively compare the features of tuberculous with chronic idiopathic pericardial effusion.
We studied 47 patients with large pericardial effusions or tamponade. All had pericardiocentesis and chest CT studies. Twenty-eight had tuberculous and 19 viral or idiopathic effusion. Pericardial biopsy was done in 26/28 and tuberculin skin test in 23/28 with tuberculosis and all received specific treatment.
Patients with idiopathic effusion were older with thinner pericardium. Tamponade was frequent in both groups (64%). Fever (p<0.001) and pericardial rub (p<0.002) were more with tuberculosis. The skin test measured 17 +/- 3.2 mm. On echocardiography pericardial deposits and strands in the pericardial space were more with tuberculosis. The fluid was similar in quantity and quality. Only and all 28 with tuberculosis had enlarged mediastinal lymph glands on CT measuring 19.5 +/- 8.3 mm. On follow up of 16 +/- 10.2 months glands disappeared in 81% and regressed in 19%. Lymphadenopathy was not seen in any patient with viral/idiopathic pericarditis. All patients in both groups were well at follow up.
Tamponade is frequent with large tuberculous and chronic idiopathic effusions. The quantity and quality of the effusion were similar. Fever and pericardial rub were more frequent with tuberculosis as also deposits and strands on echocardiography and patients had a strongly positive skin test. Mediastinal lymph gland enlargement on chest CT was found only and in all with tuberculous effusion.
在世界许多地区，结核病是心包积液的常见病因，常表现为心脏压塞。认识到这一点很重要，但并不总是容易。本研究旨在前瞻性比较结核性心包积液与慢性特发性心包积液的特征。
我们研究了47例大量心包积液或心脏压塞患者。所有患者均接受了心包穿刺和胸部CT检查。28例为结核性心包积液，19例为病毒或特发性心包积液。28例结核性心包积液患者中有26例进行了心包活检，23例进行了结核菌素皮肤试验，所有患者均接受了特异性治疗。
特发性心包积液患者年龄较大，心包较薄。两组中心脏压塞均很常见（64%）。结核病患者发热（p<0.001）和心包摩擦音（p<0.002）更为常见。皮肤试验测量值为17±3.2毫米。超声心动图显示，心包腔内的心包沉积物和条索在结核性心包积液患者中更多见。两组的心包积液量和性质相似。仅28例结核性心包积液患者在CT上显示纵隔淋巴结肿大，大小为19.5±8.3毫米。在16±10.2个月的随访中，81%的患者淋巴结消失，19%的患者淋巴结缩小。病毒/特发性心包炎患者均未出现淋巴结病。两组所有患者随访时情况良好。
大量结核性心包积液和慢性特发性心包积液常伴有心脏压塞。两组心包积液的量和性质相似。结核病患者发热、心包摩擦音更常见，超声心动图上心包沉积物和条索也更常见，且患者结核菌素皮肤试验呈强阳性。胸部CT仅在所有结核性心包积液患者中发现纵隔淋巴结肿大。
