目的 探讨不伴肝硬化的病毒性肝炎相关胸腔积液的临床特点。方法 回顾性分析2003-01至2018-03在北京积水潭医院收治的不伴肝硬化的病毒性肝炎合并胸腔积液患者的临床资料,包括生命体征、血生化及微生物学检查,胸部影像学检查,胸腔积液的生化、常规、微生物学检查,行胸腔镜检查的患者,以及病理学检查结果。结果 共有132例病毒性肝炎合并胸腔积液病例入选,排除因心、肺、肾等脏器病变,以及肝硬化、结核、肿瘤、风湿等引起的胸腔积液后,剩余6例。胸腔积液为渗出液,单侧或双侧,少量至中量。其中2例行胸腔镜检查,壁层胸膜纤维素性渗出、局部充血,少量粘连。壁层胸膜病理检查发现:纤维细胞和纤维母细胞增生,被覆纤维素性渗出及坏死;有散在的淋巴细胞浸润;大片新鲜和陈旧性出血。结论 未出现肝硬化和低蛋白血症的病毒性肝炎也可引起胸腔积液。病毒性肝炎治愈或好转后,胸腔积液可以吸收或好转。
Abstract
Objective To observe the clinical characteristics of pleural effusion with viral hepatitis without cirrhosis. Methods The clinical data of patients with viral hepatitis combined with pleura effusion treated in Beijing Jishuitan Hospital between January 2003 and March 2018 was retrospectively analyzed, involving vital signs, biochemical and microbiological examination of blood, chest imaging examination, biochemical, routine and microbiological examination of pleural effusion and pathological examination results from some patients undergoing thoracoscopy. Results A total of 132 cases of viral hepatitis with pleural effusion were selected. After the exclusion of cases of pleural effusion associated with heart, lung, and kidney diseases, or with liver cirrhosis, tuberculosis, tumour and rheumatoid, there were only 6 cases of viral hepatitis complicated with pleural effusion. The pleural effusion was exudates that were unilateral or bilateral and in small to medium quantities. Two cases underwent thoracoscopy that showed fibrous exudation of the parietal pleura, local congestion and a small amount of adhesion. Histology showed proliferation of fibrocytes and fibroblasts, and fibrous exudation and necrosis. There were scattered lymphocyte infiltrates and large tracts of fresh and old bleeding. Conclusions Viral hepatitis without cirrhosis and hypoproteinemia can also cause pleural effusion. After treatment of viral hepatitis, pleural effusion can be absorbed or improved.
关键词
胸腔积液 /
病毒性肝炎 /
肝硬化
Key words
pleural effusion /
viral hepatitis /
cirrhosis
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