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肝性胸水临床上并不少见,其形成原因不一,推测急性渗出性胸水产生于慢性活动型肝炎的活动期,是胸膜小动脉和微血管弥漫性类纤维素样坏死性血管炎或/和免疫复合物沉积所致,但缺乏确切依据。笔者兹报告2例经胸膜活检证实的病例。 例1:男,46岁。纳差、尿黄反复2年伴胸闷、气促15天于1992年8月25日入院。体检:呼吸28次/分,神志清,慢性肝病容,巩膜、皮肤黄染、口唇不绀,气管左偏,右肋间隙饱满、增宽、叩诊呈浊音,右肺呼吸音消失,左肺呼吸音清晰,心界在正常范围,心率86次/分,律齐,无病理性杂音。腹软,肝肋下3cm,剑下3cm,质中,脾未触及,无移动性浊音,肾区无叩痛,两下肢无水肿。胸片示右胸腔大量积液,B超和CT示慢性肝病、脾肿大。血Hb119g/A,WBC4.2×10~9/L,P0.65,L0.35,血小板计数72×10~9/L,ALT200u/L,AST130u/L,TSB68mmol/L,总蛋白66g/L,白蛋白47.2％,α_1球蛋白4.2％,α_2球蛋白6.1％,β球蛋白10.2％,γ球蛋白
Hepatic pleural effusion is not uncommon in clinical practice and its causes are different. It is speculated that acute exudative pleural effusion occurs during the active phase of chronic active hepatitis and is pleural arteriolar and microvascular diffuse cellulolytic necrotizing vasculitis or / and Immune complex deposition caused, but the lack of exact basis. I hereby report 2 cases confirmed by pleural biopsy. Example 1: Male, 46 years old. Anorexia, urinary yellow repeated 2 years with chest tightness, shortness of breath 15 days in August 25, 1992 admission. Physical examination: breathing 28 beats / min, clear consciousness, chronic liver disease, sclera, yellow skin, cyanotic lips, left trachea, right intercostal space full, widened, percussion dullness, right lung breath sounds disappear, left lung respiration Clear sound, the heart in the normal range, heart rate 86 beats / min, law Qi, no pathological murmur. Abdomen soft, ribs under the ribs 3cm, 3cm under the sword, the quality of the spleen not touched, no mobility dullness, no percussion pain in the kidney area, no lower extremity edema. Chest radiograph showed a large pleural effusion, B and CT showed chronic liver disease, splenomegaly. Blood Hb119g / A, WBC4.2 × 10-9 / L, P0.65, L0.35, platelet count 72 × 10-9 / L, ALT200u / L, AST130u / L, TSB68mmol / L, total protein 66g / L 47.2% of albumin, 4.2% of α_1 globulin, 6.1% of α_2 globulin, 10.2% of β globulin,