结核性缩窄性心包炎的临床特点及危险因素分析

doi:10.19871/j.cnki.xfcrbzz.2026.03.007

摘要/Abstract

摘要： 目的探讨结核性缩窄性心包炎（tuberculous constrictive pericarditis,TBCP）患者的临床特征,分析其危险因素,为临床诊断TBCP提供参考。方法回顾性收集2023年7月至2025年6月在重庆市公共卫生医疗救治中心诊断为结核性心包炎（tuberculous pericarditis,TBP）的118例患者临床资料,根据是否进展为缩窄性心包炎分为TBCP组（67例）和非TBCP组（51例）。比较两组患者的临床特征,并对是否行心包穿刺进行分层分析;采用多因素Logistic回归分析TBCP发生的独立危险因素。结果与非TBCP组患者相比,TBCP组患者发病病程更长,临床症状以咳嗽伴喘累为主要表现,组间差异均具有统计学意义（均P<0.05）。实验室检查结果显示,与非TBCP组相比,TBCP组患者肌钙蛋白、脑钠肽前体、总胆红素、间接胆红素水平均显著升高,直接胆红素、血沉水平显著降低,上述组间差异均有统计学意义（均P<0.05）。影像学特征显示,TBCP组患者具有特征性室间隔弹跳征,同时存在心包膜增厚、少量心包积液及双心房扩大表现。血流动力学检查提示,与非TBCP组相比,TBCP组上腔静脉压、右心房压、右心室压、肺动脉压及肺动脉楔压升高,而心指数及心输出量下降,上述差异均具有统计学意义（均P<0.05）。干预措施分析显示,穿刺组心包缩窄发生率为40.0%（22/55）,显著低于非穿刺组的71.4%（45/63）,差异具有统计学意义（P=0.001）。多因素Logistic回归分析结果提示,发病时间（OR=1.480,95%CI：1.150~1.910）、心包膜厚度（OR=1.470,95%CI：1.090~2.000）、心包积液量（OR=0.920,95%CI：0.860~0.980）是TBCP发生的独立影响因素。结论 TBCP患者病程较长、以咳嗽伴喘累为主要表现,伴特征性实验室、影像学及血流动力学改变,心包穿刺术可降低其TBCP的发生风险。发病时间延长、心包膜厚度增加是TBCP的独立危险因素,心包积液量增加是其独立保护因素,临床需重视上述特征,加强早期干预以降低发病风险

关键词: 缩窄性心包炎, 结核病, 心包穿刺术, 临床特点, 危险因素

Abstract: Objective To investigate the clinical characteristics of patients with tuberculous constrictive pericarditis(TBCP) and analyze its risk factors,so as to provide a reference for the clinical diagnosis of TBCP. Method Clinical data of 118 patients diagnosed with tuberculous pericarditis(TBP) at Chongqing Public Health Medical Center from July 2023 to June 2025 were retrospectively collected.Patients were divided into a TBCP group(n=67) and a non-TBCP group(n=51) based on the progression to constrictive pericarditis. Clinical data were compared between the two groups. A stratified analysis was performed based on whether pericardial puncture was performed.Multivariate logistic regression was used to identify independent risk factors for TBCP. Result Compared with patients in the non-TBCP group, patients in the TBCP group had a longer disease course, and their main clinical symptom was cough accompanied by dyspnea on exertion, with statistically significant differences between the groups (all P<0.05). Laboratory examination results showed that compared with the non-TBCP group, the levels of troponin, N-terminal pro-brain natriuretic peptide, total bilirubin, and indirect bilirubin in the TBCP group were significantly higher, while the levels of direct bilirubin and erythrocyte sedimentation rate were significantly lower, and all the above inter-group differences were statistically significant (all P<0.05). Imaging characteristics showed that patients in the TBCP group had a characteristic septal bounce, accompanied by pericardial thickening, a small amount of pericardial effusion, and biatrial enlargement. Hemodynamic examination suggested that compared with the non-TBCP group, the superior vena cava pressure, right atrial pressure, right ventricular pressure, pulmonary artery pressure, and pulmonary artery wedge pressure in the TBCP group were increased, while the cardiac index and cardiac output were decreased, and all the above differences were statistically significant (all P<0.05). Intervention analysis showed that the incidence of pericardial constriction was 40.0% (22/55) in the pericardiocentesis group, which was significantly lower than 71.4% (45/63) in the non-pericardiocentesis group, with a statistically significant difference (P=0.001). The results of multivariate Logistic regression analysis indicated that the duration of illness (OR=1.480, 95%CI: 1.150-1.910), pericardial thickness (OR=1.470, 95%CI: 1.090-2.000), and pericardial effusion volume (OR=0.920, 95%CI: 0.860-0.980) were independent influencing factors for the occurrence of TBCP. Conclusion Patients with TBCP have a longer course of disease, mainly presenting with cough accompanied by fatigue, along with characteristic changes in laboratory tests, imaging, and hemodynamics, and pericardiocentesis can reduce the risk of its occurrence. Prolonged duration of illness and increased pericardial thickness are independent risk factors for TBCP, while increased pericardial effusion volume is an independent protective factor. Clinically, attention should be paid to the above characteristics, and early intervention should be strengthened to reduce the incidence risk.

Key words: Constrictive pericarditis, Tuberculosis, Pericardiocentesis, Clinical characteristics, Risk factors

中图分类号:

熊艳美, 孙楠楠, 岑武强, 胡清亮. 结核性缩窄性心包炎的临床特点及危险因素分析[J]. 新发传染病电子杂志, 2026, 11(3): 36-41.

Xiong Yanmei, Sun Nannan, Cen Wuqiang, Hu Qingliang. Clinical characteristics and risk factors of tuberculous constrictive pericarditis[J]. Electronic Journal of Emerging Infectious Diseases, 2026, 11(3): 36-41.

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