犬心包积液的超声心动图和临床病理学特征：107 例 （1985–2006）

1 摘要

目的：评价超声心动图诊断犬心包积液心脏肿块的敏感性和特异性。

设计：回顾性案例系列。

动物：107 只患有心包积液的狗。

程序：回顾了 1985 年至 2006 年在加州大学戴维斯分校兽医教学医院检查的心包积液狗的记录。狗狗进行了包括超声心动图、心包切除术或尸检。计算了心包积液各种病因的敏感性、特异性和转移率。

结果： 107 只心包积液犬通过手术 （n = 48 ） 、尸检 （44） 或两者皆进行 （15） 进行评估。超声心动图显示无肿块 （n = 41）、右心房 （RA） 肿块 （38）、心基 （HB） 肿块 （23）、心包肿块 （2）、HB 和 RA 肿块 （2） 以及右心室肿块 （1）。检测心脏肿块的敏感性和特异性分别为 82% 和 100%；分别为 82% 和 99% 用于检测 RA 质量；分别为 74% 和 98% 用于检测 HB 肿块。大多数 HB 肿块为神经内分泌或异位甲状腺组织，但 3 例为血管肉瘤，4 例为间皮瘤。大多数 RA 肿块是血管肉瘤，但该组还包括神经内分泌肿瘤、异位甲状腺组织、间皮瘤、淋巴肉瘤和肉瘤。肿瘤病因的转移率没有差异（50%-66%）。

结论与临床相关性：超声心动图对心包积液犬的 RA 或 HB 肿块的诊断和鉴别具有较高的敏感性和特异性。所有原因导致的心脏肿块的转移率都很高。（J Am Vet Med Assoc 2009;235:1456–1461)

2 正文

心包积液是狗中一种相当常见的获得性心脏病。据报道，在转诊兽医医院检查的狗的患病率为 0.43% （1/233），在有心脏病临床症状的狗中，患病率约为 7%。[1] 它是一种多发病因疾病，预后范围广泛，从良好到严重不等。[2] 狗心包积液的最常见原因包括右心房血管肉瘤、特发性心包炎和心脏基底化学感受器瘤。[3–5]

Pericardial effusion is a fairly common acquired cardiac condition in dogs. Prevalence has been reported to be 0.43% (1/233) for dogs examined at a referral veterinary hospital, and it accounts for approximately 7% of dogs with clinical signs of cardiac disease.[1] It is a multiple-etiologic disorder with a wide spectrum of prognoses that range from good to grave.[2] The mostcommon causes of pericardial effusion in dogs include hemangiosarcoma of the right atrium, idiopathic pericarditis, and chemodectoma of the heart base.[3–5]

确定心包积液的病因可提供有关适当治疗、临床进展和预后的宝贵信息。继发于肿瘤性原因的心包积液的狗预后不良，存活时间从 26 到 56 天不等，这比继发于非肿瘤性原因的心包积液的狗的较长生存时间 790 到 1,068 天要短得多。[3,6] 继发于心脏基础肿块的心包积液的狗通常比患有血管肉瘤的狗预后更好， 特别是当他们接受心包切除术时。[7–9] 接受心包切除术的心脏基底肿块的狗比未接受心包切除术的狗存活时间（中位生存时间，730 天）更长（中位生存时间，42 天）[7]。

Determination of the cause of pericardial effusion provides valuable information regarding appropriate treatment, clinical progression, and prognosis. Dogs with pericardial effusion secondary to neoplastic causes have a poor prognosis, with survival times ranging from 26 to 56 days, which is substantially shorter than the longer survival times of 790 to 1,068 days for dogs with pericardial effusion secondary to nonneoplastic causes.[3,6] Dogs with pericardial effusion secondary to a heart base mass typically have a better prognosis than dogs with hemangiosarcoma, especially when they undergo pericardectomy.[7–9] Dogs with heart base masses that underwent pericardectomy survived longer (median survival time, 730 days) than those that did not undergo pericardectomy (median survival time, 42 days).[7]

超声心动图是诊断心包积液以及评估病因的重要程序，包括心脏肿块的识别和定位、结构性或功能性心脏病的检测以及积液严重程度的评估，用于定义治疗计划。 首次检查的敏感性在 17% 到 50% 之间变化，重复检查时增加到 69%[4,11] 然而，尚未进行任何研究来评估超声心动图区分右心房肿块和心脏基底肿块的敏感性或特异性，这通常具有预后意义。此外，上述许多研究都是使用缺乏现代超声机的分辨率和帧速率的超声机进行的。

Echocardiography is an essential procedure for diagnosis of pericardial effusion as well as evaluation of the cause, including the identification and location of cardiac masses, detection of structural or functional cardiac disease, and assessment of the severity of the effusion, for use in defining a therapeutic plan.10 There is a wide range in the reported sensitivity for echocardiographic detection of cardiac masses, which varies between 17% and 50% for first-time examinations and increases to 69% for repeat examinations.[4,11] However, no studies have been conducted to evaluate the sensitivity or specificity of echocardiography for distinguishing right atrial masses from heart base masses, which often has prognostic implications. In addition, many of the aforementioned studies were performed with ultrasound machines that lacked the resolution and frame rates of modern ultrasound machines.

此报告的研究具体目标是确定超声心动图在检测心包积液狗的心脏肿块、区分右心房肿块与心包积液的其他原因以及区分心基底肿块与心包积液的其他原因的敏感性和特异性。次要目标包括确定心脏内肿瘤的具体肿瘤原因和位置，比较心包积液肿瘤原因的转移率，以及描述心包积液狗的临床病理异常。

The specific objectives of the study reported here were to determine the sensitivity and specificity of echocardiography for detection of a cardiac mass in dogs with pericardial effusion, for distinguishing right atrial masses from other causes of pericardial effusion, and for distinguishing heart base masses from other causes of pericardial effusion. Secondary objectives included defining the specific neoplastic causes and locations of neoplasms within the heart, comparing metastatic rates of neoplastic causes of pericardial effusion, and characterizing clinicopathologic abnormalities in dogs with pericardial effusion.