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结核性心包炎

Author
Jason Stout, MD
Section Editor
C Fordham von Reyn, MD
Deputy Editor
Elinor L Baron, MD, DTMH

引言

结核性心包炎是结核病(tuberculosis, TB)的一个重要并发症；可能难以确立诊断，因此诊断常常被延迟或漏诊，从而导致诸如缩窄性心包炎的一些晚期并发症和死亡率增加[1]。疾病晚期可选择的治疗较为有限。

结核性心包炎评估和治疗的相关问题将总结在此。结核病诊断和治疗相关的一般问题将单独讨论。 (参见“Epidemiology, clinical manifestations, and diagnosis of tuberculosis in HIV-infected patients”和“HIV阴性患者的肺结核治疗”和“HIV成人感染者的肺结核治疗”)

流行病学

约1%-2%的肺结核患者出现结核性心包炎[2]。在一项纳入294例有急性心包炎(病因在初始评估时并不明显)而免疫功能正常的西班牙患者的病例系列研究中，13例患者(病例的4%)被诊断出结核性心包炎[3]。观察到5例患者发生心包压塞，6例患者发生缩窄性心包炎。

在人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染率高的发展中国家，结核性心包炎已出现急剧增加。例如，1994年的一项关于有大量心包积液的坦桑尼亚患者的病例系列研究发现，所有HIV感染者都被发现有结核性心包炎[4]。

在美国，伴随结核病患病率下降的同时，结核性心包炎的发病率已有下降[5-7]。但是，在有来自结核病流行国家大量移民人口的美国某些地区，仍会不时见到包括结核性心包炎在内的肺外结核[8-10]。

                    

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-19.
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