Hugo-Hamman C T, Scher H, De Moor M M
Department of Paediatrics and Child Health, University of Cape Town, South Africa.
Pediatr Infect Dis J. 1994 Jan;13(1):13-8. doi: 10.1097/00006454-199401000-00004.
This retrospective study reports experience in 44 children with pericardial tuberculosis seen during a 6-year period, 1986 to 1991. Thirty-seven children presented with pericardial effusion (PE), 4 with constrictive pericarditis and 3 with effusive constrictive disease. Features of cardiac tamponade were present in 90%, and in 91% radiologic cardiomegaly was found. A two-dimensional echocardiogram is diagnostic for PE. Culture and biopsy yields for Mycobacterium tuberculosis were low (18%). The Mantoux test was positive (> 10 mm) in 75%. In 14 patients doubt about etiology necessitated treatment for possible pyogenic infection with anterior pericardiotomy as opposed to diagnostic pericardiocentesis with catheter drainage. Twelve cases with PE were treated with steroids and the other 25 received only anti-tuberculous medication. Five cases of PE developed constrictive pericarditis during treatment of whom none received steroids. No statistically significant differences were demonstrated between the two groups. Only 5 of the 12 cases with constrictive pericarditis required pericardiectomy. There were no deaths and recovery has been complete in 43 cases. This study shows that tuberculous pericardial disease is common in areas with a high prevalence of tuberculosis. Prognosis is excellent for a condition in which morbidity and mortality have previously been high.
这项回顾性研究报告了1986年至1991年6年间44例儿童心包结核的诊治经验。37例患儿表现为心包积液（PE），4例为缩窄性心包炎，3例为渗出性缩窄性病变。90%的患儿存在心脏压塞特征，91%的患儿有影像学心脏增大。二维超声心动图可诊断心包积液。结核分枝杆菌的培养和活检阳性率较低（18%）。结核菌素试验阳性（>10mm）的患儿占75%。14例病因不明的患儿因怀疑可能为化脓性感染而接受了前心包切开术治疗，而非采用导管引流的诊断性心包穿刺术。12例心包积液患儿接受了类固醇治疗，另外25例仅接受抗结核药物治疗。5例心包积液患儿在治疗过程中发展为缩窄性心包炎，其中无一例接受类固醇治疗。两组之间未显示出统计学上的显著差异。12例缩窄性心包炎患儿中只有5例需要心包切除术。无一例死亡，43例患儿已完全康复。这项研究表明，结核性心包疾病在结核病高发地区较为常见。对于一种以往发病率和死亡率都很高的疾病来说，其预后极佳。
