老年人缩窄性心包炎的特点

Constrictive pericarditis: a retrospective analysis of 48 elderly patients compared with 102 young patients

目的探讨老年人缩窄性心包炎的临床特点,并与非老年人比较。方法回顾性总结我院2000—2007年连续诊断的缩窄性心包炎患者门诊与住院资料,对60岁以上老年患者与非老年患者临床与病理情况进行比较分析。结果 150例中,48例为老年人,占32.0%,非老年人102例。结核分别占83.3%和76.5%(P>0.05)。老年人胸痛、呼吸困难的发生率和心包积液检出率均高于非老年人,分别是87.5%比59.8%(P=0.0006),79.2%比52.0%(P=0.0074),腹腔积液发生率老年人明显低于非老年,分别是32.2%比52.9%(P=0.0129),结核性腹膜炎发生率为6.3%比35.2%(P=0.0456);心律失常在两组各为6例,但老年组的心律失常均为持续不可逆的;老年组32例(66.7%)存在62种合并症,非老年组仅13例(12.8%)存在合并症(P<0.001);老年组心包剥脱手术率明显低于非老年组(56.3%比80.4%,P=0.002),70岁以上手术治疗率仅25.9%;病死率两组相似,分别为6.3%比9.8%(P>0.05)。结论老年人缩窄性心包炎发病率不低,结核也是老年人缩窄性心包炎的最常见病因;临床表现与非老年人比较有一定特殊性,合并症多,心包剥脱手术率随年龄增长下降;病死率、近期预后与非老年人相似。

Objective To investigate the differences of clinical features between elderly and young patients with constrictive pericarditis. Methods The medical records of patients with constrictive periearditis diagnosed in Peking Union Medical College Hospital after 2000 were reviewed for comparison of the clinical and pathological characteristics between elderly ≥160 years old） and young patients. Results A total of 150 patients were enrolled in this study, of those 48 （32.0%） were elders. Tuberculosis was the most common cause of constrictive pericarditis in both elderly and young patients （83.3% vs. 76.5% , P 〉 0.05）. Dyspnea and chest pain, as well as pericardial effusion, were more common in elderly patients than in young patients （87. 5% vs. 59. 8%, P = 0. 0006 and 79. 2% vs. 52. 0%, P = 0. 0074, respectively）. The incidence of ascites and tuberculous peritonitis were lower in elderly patients than in young patients （32.2% vs. 52.9% , P = 0. 0129 and 6.3% vs. 35.2% , P = 0. 0456, respectively）. The incidence of arrhythmia was similar in the two groups. Compared with young patients, more elderly patients had concomitant diseases （66.7% vs. 12. 8% , P 〈0. 001 ）. The rate of pericardiectomy was significantly lower in elderly patients than in young patients （56.3% vs. 80.4%, P=0.002）. Mortality was similar in the two groups （6.3% vs. 9. 8%, P 〉0.05）. Conclusions Constrictive pericarditis is common in elderly patients and tuberculosis is the major cause of constrictive pericarditis in China. Compared to young patients, elderly patients with constrictive pericarditis have different clinical features. The outcome of elderly patients with constrictive pericarditis is similar to young patients.