无结核证据的心包积液患者诊断性抗结核治疗的有效性和合理性分析

发布时间：2018-10-13 10:58

【摘要】：结核性心包炎是一种由结核分枝杆菌感染的慢性进展性疾病,临床表现并不特异,其诊断仍以心包积液培养和心包组织活检作为金标准,临床诊断缺乏快速高效的方法,因此结核性心包炎在临床工作中经常被延误甚至误诊。在除外肿瘤性、风湿免疫性、非结核感染性疾病后,高度怀疑结核性心包炎的患者,可行抗结核治疗;但在无明确结核证据的群体中,诊断性抗结核治疗的必要性、有效性和安全性并不明确。本研究通过回顾性分析除外肿瘤性、风湿免疫性、非结核感染性、高度可疑结核感染性等病因后,仍无结核证据、原因不明的中、大量心包积液患者的临床资料,明确诊断性抗结核治疗的标准,评估治疗的有效性及安全性,对临床有重要的指导意义。目的:研究临床充分除外肿瘤性、风湿免疫性、非结核感染性病因后,仍无结核证据的中、大量心包积液患者诊断性抗结核治疗的有效性和合理性。方法:回顾性分析2013年1月至2016年9月就诊北京协和医院心内科、普通内科、感染内科以“心包积液原因待查”住院治疗的中、大量心包积液患者,全面筛查除外肿瘤、免疫、感染等相关疾病,仍无明确结核证据同时接受诊断性抗结核治疗的患者纳入研究组;另选取同期结核性心包炎诊断明确或高度可疑,并接受抗结核治疗的患者作为对照组。通过统计学分析研究组与对照组患者的症状缓解情况、心包积液缓解情况以及临床转归,以评估无结核证据的心包积液患者诊断性抗结核治疗的有效性和合理性。结果:57例心包积液患者按照分组标准分为研究组25例,对照组32例,两组患者均规律抗结核治疗,经统计学分析抗结核治疗情况、临床症状缓解情况、心包积液缓解情况、临床转归均无明显差异(P0.05)。结论:在不明原因就诊的心包积液患者中,全面筛查除外肿瘤性、风湿免疫性、感染性疾病后,对无结核证据的心包积液患者,可行诊断性抗结核治疗。
[Abstract]:Tuberculous pericarditis is a chronic progressive disease infected by Mycobacterium tuberculosis. The clinical manifestation is not specific. The diagnosis of tuberculous pericarditis is still based on pericardial effusion culture and pericardial biopsy. Therefore, tuberculous pericarditis is often delayed or misdiagnosed in clinical work. Patients with highly suspected tuberculous pericarditis who are highly suspected of tuberculous pericarditis, excluding tumorous, rheumatic immunological, non-tuberculous infectious diseases, are eligible for anti-tuberculosis treatment; but in populations where there is no clear evidence of tuberculosis, diagnostic anti-tuberculosis treatment is necessary, Effectiveness and safety are unclear. After retrospective analysis of the etiological factors, such as tumor, rheumatism immunity, non-tuberculosis infection and highly suspected tuberculosis infection, there is no evidence of tuberculosis. The clinical data of a large number of patients with pericardial effusion are unknown. It is important for clinical practice to clarify the criteria of diagnostic antituberculous therapy and to evaluate the efficacy and safety of the treatment. Objective: to study the effectiveness and rationality of diagnostic antituberculotic therapy in large numbers of pericardial effusion patients without evidence of tuberculosis after clinical full exclusion of tumor rheumatism immunity and non-tuberculosis infection. Methods: from January 2013 to September 2016, a large number of patients with pericardial effusion in Department of Cardiology, General Department of Internal Medicine and Department of infection in Beijing Union Hospital were retrospectively analyzed. Infection and other related diseases, there is still no clear evidence of tuberculosis and accept diagnostic anti-tuberculosis treatment of patients into the study group; another period of tuberculous pericarditis diagnosis is clear or highly suspicious, and receive anti-tuberculosis treatment patients as the control group. In order to evaluate the effectiveness and rationality of diagnostic antituberculotic therapy in patients with pericardial effusion without evidence of tuberculosis, the symptom relief, the relief of pericardial effusion and the clinical outcome of the patients in the study group and the control group were analyzed statistically. Results: according to the criteria, 57 patients with pericardial effusion were divided into study group (n = 25) and control group (n = 32). There was no significant difference in clinical outcome (P0.05). Conclusion: in the patients with pericardial effusion with unknown cause, it is feasible to diagnose antituberculosis therapy in patients with pericardial effusion without evidence of tuberculosis after comprehensive screening, excluding tumor, rheumatism immunity and infectious diseases.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.1

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