Department of Internal Medicine and Cardiology, UKGM GmbH Giessen and Marburg, Marburg Heart Center and Faculty of Medicine, Philipps-University, Marburg, Germany.
Prog Cardiovasc Dis. 2010 Sep-Oct;53(2):157-63. doi: 10.1016/j.pcad.2010.06.003.
The incidence and extent of pericardial involvement in neoplastic disease varies. In a considerable number of patients with breast or lung cancer or with mediastinal lymphoma, in addition to direct involvement by the tumor, radiation therapy as well as systemic tumor treatment can also lead to pericardial effusion. In addition, in immunosuppressed tumor patients, pericardial effusion can also arise from viral, bacterial, and autoimmune causes. To distinguish between these 3 different conditions leading to pericardial effusion, the diagnosis should be based on pericardiocentesis followed by fluid analysis for cytology and biomarkers, on epicardial and pericardial biopsy facilitated by flexible pericardioscopy with analysis of specimens by conventional histology and molecular biology techniques for viral and microbial aetiology. We collected prospectively but analyzed retrospectively 357 patients undergoing pericardiocentesis from 1988 to 2008 and identified 68 patients who had cancer-related pericardial effusion. With these methods, 42 patients demonstrated malignant effusion, 15 patients had radiation-induced pericardial, effusion, and in 11 patients without radiation therapy, the effusion could be attributed to either viral infection in 5 cases or to an autoimmune process in the remaining 6 patients. Consequently, intrapericardial treatment could be tailored for each cohort: neoplastic effusion was treated with intrapericardial cisplatin (single instillation of 30 mg/m(2) per 24 hours); in addition to the tumor-specific systemic chemotherapy, intrapericardial triamcinolone acetate (Volon A) was given in a dose of 500 mg/m(2) in the patients with autoimmune and radiation-induced effusion. Saline rinsing and intrapericardial sclerosing treatment were the treatment of choice in viral pericardial effusion. Oral colchicine treatment (2-3 x 0.5 mg) was given in all patients for at least 3 months. Recurrence of pericardial effusion was prevented for at least 3 months in more than 85% of patients. This differential diagnostic approach and the results of treatment were compared with published series.
肿瘤性疾病累及心包的发生率和程度各不相同。在相当数量的乳腺癌、肺癌或纵隔淋巴瘤患者中，除了肿瘤直接累及心包外，放射治疗以及全身肿瘤治疗也可导致心包积液。此外，在免疫抑制的肿瘤患者中，心包积液也可由病毒、细菌和自身免疫原因引起。为了区分导致心包积液的这 3 种不同情况，诊断应基于心包穿刺，然后对积液进行细胞学和生物标志物分析，通过心包镜进行心外膜和心包活检，对标本进行常规组织学和分子生物学技术分析，以确定病毒和微生物病因。我们前瞻性地收集了 1988 年至 2008 年期间 357 例心包穿刺患者的数据，并确定了 68 例有癌相关性心包积液的患者。通过这些方法，42 例患者证实为恶性积液，15 例患者为放疗相关性心包积液，在 11 例未接受放疗的患者中，5 例为病毒感染，6 例为自身免疫过程。因此，可以为每个队列量身定制心包内治疗：肿瘤性积液采用顺铂心包内注射（每 24 小时单剂量 30mg/m2）；除了肿瘤特异性全身化疗外，对于自身免疫和放疗相关性积液患者，给予曲安西龙（醋酸曲安奈德，Volon A）心包内注射，剂量为 500mg/m2。对于病毒性心包积液，采用盐水冲洗和心包内硬化治疗。所有患者均给予秋水仙碱（2-3 x 0.5mg）口服治疗至少 3 个月。85%以上的患者至少 3 个月内预防了心包积液复发。这种鉴别诊断方法和治疗结果与已发表的系列结果进行了比较。
