慢性乙型病毒性肝炎并胸腔积液误诊为结核性胸膜炎  

Chronic Hepatitis B Combined With Pleural Effusion:A Case Report

作　　者：郭先文[1] 黄丹[1] 雷荣娥[1] 梁列新[1] 

机构地区：[1]广西壮族自治区人民医院消化内科,南宁530021

出　　处：《临床误诊误治》2013年第4期72-74,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的提高对慢性乙型病毒性肝炎(乙肝)合并胸腔积液的认识,减少漏诊、误诊。方法对1例慢性乙肝合并胸腔积液的临床资料进行回顾性分析,并复习文献,对其发病机制、临床表现、诊断及治疗方法进行探讨。结果患者1月余前体检发现肝酶升高,在外院经肝脏穿刺活检病理检查报告为中度慢性肝炎(G3S3),临床诊断为活动期慢性乙肝,予恩替卡韦抗病毒治疗。住院期间出现胸痛、气促,胸痛呈持续性胀痛,伴腹胀,胸腔B超检查示右侧胸腔积液,诊断为结核性胸膜炎,停用抗病毒药物,应用HREZ方案抗结核治疗及胸腔闭式引流术,效果不佳,转我院。查胸腔积液乙肝病毒标志物示HBsAg、HBeAb、HBcAb均(+),HBV-DNA 1.1×103U/ml,确诊为慢性乙肝并胸腔积液,予抗病毒及糖皮质激素治疗,胸腔积液消除,随访1年未复发。结论慢性乙肝出现胸腔积液时,应注意与结核性胸膜炎鉴别,检测胸腔积液乙肝病毒标志物和HBV-DNA有助于诊断。Objective To improve the awareness of chronic hepatitis B combined with pleural effusion, and to reduce the misdiagnosis rate. Methods Clinical data of 1 patient with chronic hepatitis B combined with pleural effusion was retrospectively analyzed, and relative literature was reviewed. The pathogenesis, clinical manifestations, diagnoses and therapeutic methods were explored. Results The physical examination showed elevated hepatic enzymes in the patient l month before, and was diagnosed as having moderate chronic hepatitis （ G3 S3 ） by puncture biopsy pathological examination in other hospitals. The clinical diagnosis was chronic viral hepatitis type B （active period）, and enteeavir antiviral therapy was applied. The patient suffered chest pains with continuity distending pain and abdominal distension, and short breath. Thorax ultrasound revealed a pleural effusion in the right chest. The patient was diagnosed as having tuberculous pleuritis, and antiviral medication therapy was suspended. HREZ anti-tuber- culotic therapy and closed thoracic drainage were applied, but symptoms did not improve. The patient was transferred to our hospital for further treatment. The diagnosis of chronic hepatitis B combined with pleural effusion was confirmed by pleural effusion and HBV markers of positive HBsAg, HBeAb and HBcAb, the HBV-DNA studies showed 1.1 × 103 U/ml. Pleural effusion rapidly regressed after anti-viral drug and glucocorticoid treatment, and there was no recurrence during 1 year follow-up. Conclusion When the patient with viral hepatitis type B showed symptoms of hydrothorax, clinicians should pay attention to differentia diagnosis with tuberculous pleurisy. Detections of hepatitis B virus markers and DNA in the pleural effusion are important in diagnosis.

关 键 词：肝炎 乙型 慢性 胸腔积液 误诊 结核 

分 类 号：R512.62[医药卫生—内科学]