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目的探讨结核性心包炎患者快速进展至心包缩窄的临床特征、预测因素和治疗预后。方法将58例结核性缩窄性心包炎患者,分为快速进展性结核性缩窄性心包炎(快速进展组)和普通结核性缩窄性心包炎(普通组)两组,分析两组患者在临床特征和治疗预后等方面的差异,回归分析各相关因素的预后判断价值。结果12例患者在3个月内即发生心包缩窄,诊断为快速进展性结核性心包炎,其中心包填塞、血性心包积液、心包积液纤维素样物质漂浮、肝功能损害等指标在快速进展性结核性心包炎组显著高于普通组。快速进展性缩窄性心包炎患者往往病情更重,治疗更困难,但及时的手术治疗仍可降低其死亡率。结论心包填塞、血性心包积液和心包积液纤维素样物质漂浮可预测急性结核性心包炎快速进展至心包缩窄,此类患者如形成缩窄,亦应及时手术治疗。
Objective To investigate the clinical features, predictors and prognosis of patients with rapidly progressing tuberculous pericarditis to pericardial constriction. Methods Fifty-eight patients with tuberculous constrictive pericarditis were divided into two groups: rapid progressing tuberculous constrictive pericarditis (rapid progress group) and common tuberculous constrictive pericarditis (common group) The differences of clinical characteristics and treatment prognosis were analyzed by regression analysis to evaluate the prognostic value of various related factors. Results In 12 patients, pericardial constriction occurred within 3 months, and the diagnosis was rapid progressing tuberculous pericarditis. The indexes of pericardial tamponade, bloody pericardial effusion, pericardial effusion of cellulose-like substance, and hepatic dysfunction were in the Fast-progress group of tuberculous pericarditis was significantly higher than the normal group. Patients with rapidly progressive constrictive pericarditis tend to be more afflicted and more difficult to treat, but timely surgical treatment may reduce their mortality. Conclusions Pericardial tamponade, bloody pericardial effusion and pericardial effusion of cellulose-like material can predict the rapid progression of acute tuberculous pericarditis to narrowed pericardium. Such patients should undergo timely surgical treatment if their constriction is formed.