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1 病例摘要患儿女性,12岁,因咳嗽月余,气促10余天,颜面浮肿3天入院。体检:营养发育中等,呼吸稍促,眼睑浮肿,气管居中,两下肺叩浊,语音减低,呼吸音低,无干湿罗音;心界左乳线外0.5cm,心音稍偏低,心律齐,无杂音;腹软,肝肋下6cm,剑下8cm,质中,脾肋下2cm,腹部移动性浊音阳性。辅助检查:血红蛋白119g/L,白细胞 13.8×10~9/L,中性 0.29,血小板数192×10~9/L。胸片、超声心动图、胸腹B超提示双侧胸腔积液,少量心包积液及腹水。胸水常规:黄色,李凡他试验弱阳性,细胞数 0.58×10~9/L,单核 0.82,细菌未找到。心电图示广泛T波改变。肝功能正常,血清HBV检查示HBsAg阴性,pre—s_2阴性,抗HBs阳性,抗HBc IgM阴性,抗HBe阳性;胸水HBV检查示抗HBs阳性,抗HBe阳性,PPD试验++～+++,血沉三次检查正常,抗核抗体,抗“O”,GOT,CPK,LDH,C—反应蛋
1 case summary Children with children, aged 12, due to cough more than a month, shortness of breath more than 10 days, face edema 3 days admission. Physical examination: medium nutrition development, breathing a little quick, eyelid edema, tracheal center, two lung knock turbidity, voice reduced, low breath sounds, no dry rales; heart left chest outside the line 0.5cm, slightly lower heart sound, heart rate Qi, no noise; abdomen soft, liver ribs 6cm, sword 8cm, quality, spleen ribs 2cm, abdominal mobility dullness positive. Assisted examination: hemoglobin 119g / L, white blood cells 13.8 × 10 ~ 9 / L, neutral 0.29, platelet count 192 × 10 ~ 9 / L. Chest radiograph, echocardiography, chest and abdomen B-ultrasound prompted bilateral pleural effusion, a small amount of pericardial effusion and ascites. Pleural effusion routine: yellow, Li where he test weakly positive, the number of cells 0.58 × 10 ~ 9 / L, mononuclear 0.82, bacteria not found. ECG T wave broad changes show. Normal liver function, serum HBV test showed negative HBsAg, pre-s_2 negative, anti-HBs positive, anti-HBc IgM negative, anti-HBe positive; pleural fluid HBV test showed anti-HBs positive, anti HBe positive, PPD test ++ ~ ESR three times normal, anti-nuclear antibodies, anti-“O”, GOT, CPK, LDH, C-reactive egg