摘要目的 总结结核所致缩窄性心包炎的临床特点与病理改变.方法 对北京协和医院2000至2007年诊断的150例缩窄性心包炎病例的临床表现与病理特征进行回顾性分析.结果 在150例患者中,61例(40.7%)无心包积液史.超声心动图诊断心包缩窄149例,与手术诊断的一致率为98.7%(107/109).118例(78.7%)诊断为结核性,24例(16.0%)为肿瘤转移或浸润、放射性损伤、心脏手术后等其他原因,8例(5.3%)原因不明.经病理或病原学检查确诊为结核性心包炎者占16.7%(25/150);有心包外活动性结核病理证据者占5.3%(8/150);有典型的结核病临床表现或因抗结核治疗有效诊断者占44.0%(66/150);临床怀疑结核者占12.7%(19/150).108例患者接受心包剥脱术,1例行心包活检和心包切开引流术.死亡13例(8.7%),4例为结核.结论 结核仍然是缩窄性心包炎的最常见病因.心包结核多为全身结核病的一部分,但心包病理和病原学检查阳性率低.超声心动图对诊断缩窄性心包炎具有较高的实用价值.

abstractsObjective To summarize the clinical and pathological characteristics of constrictive pericarditis in Chim.Method Data from 150 patients with constrictive pericarditis who admitted to our hospital from 2000 to 2007 were retrospectively analyzed.Results Constriction pericarditis was detected b、r echocardiography in 149 out of 150 patients.Pericardial effusion Wag evidenced in 59.3% patients ( 89/150).The diagnostic accuracy rate for identifying constrictive pericarditis by echocardiography(98.7%,107/109)Wfm comparable to that of surgical diagnosis (100%,109/109).Tuberculosis was the main cause of constrictive pericarditis in this cohort (78.7%,1 18/150) including 25 (16.7%) cases with pathological or etiological evidencos of tubercular pericarditis,8(5.3%)cases with pathololocally active tuberculotIS focus elsewhere in the body,66 (44.O%)Cases with typical clinical tuberculosis manifesmfion and responded to anti-tubercular therapy and 19(12.7%) cases with a diagnosis of suspicious tuberculosis.Pericardiectomy was performed in 108 cases and pericardial biopsy and surgical drainage WaS performed in 1 patient.In hospital death rate wag 8.7%(13/150,4 tubereular patients and 9 non-tubercular).Conclusion Tuberculosis iS the leading cause of constrictive pericarditis in this cohort and the best diagnosis tool is echocardiography other than pathological and etiological findings in pericardium.