患者男性,28岁,因反复气急咳嗽腹胀4月,加重15天,于1998年1月11日第1次入本院。患者入院前曾在当地医院疑诊为“结核性渗出性心包炎、肺部感染”而予以抗痨、抗炎等治疗3月余,并作心包穿刺2次,每次抽出淡黄色心包液1000ml,症状无好转且逐渐加重。在当地多次化验血常规血细胞数均正常,淋巴细胞比例在0.6～0.78,否认过去有结核病病史及肝炎病史。入院体检:呈端坐位,呼吸急促,呼吸36次/min,口唇发绀明显,肝—颈静脉回流征阳性,胸骨有明显压痛,双肺满布哮鸣音,心率107次/min,心律齐,未闻及心包摩擦音,心界向双侧扩大,血压16/10.5kPa,肝肋下2.0cm.脾肋下2.5cm,质中,无触痛,皮肤粘膜未见出血点,双下肢无浮肿,未及奇脉,未及肿大浅表淋巴结。血常规检查示:白细胞数4.7×10~9/L,Hb141g/L,血小板数240×10~9/L,淋巴细胞比例0.87;分类:原淋+幼淋占0.34。X线胸片示:心影增大,肺部浸润伴感染。心脏超声检查示:心包少量积液,局部心包增厚。B超示:肝脾肿大。骨髓常规检查示:有核细胞增生明显活跃,淋巴细胞极度增生,以原始淋巴细胞为主,原淋 Male patient, 28 years old, due to repeated shortness of breath cough and abdominal distension in April, increased 15 days, on January 11, 1998 the first time into our hospital. Patients admitted to the hospital was previously suspected in the local hospital as “tuberculous exudative pericarditis, pulmonary infection” and to anti-tuberculosis, anti-inflammatory treatment for more than 3 months and pericardial puncture 2 times, each time out of the light yellow pericardial fluid 1000ml, the symptoms did not improve and gradually increased. In many local blood routine blood test normal number of lymphocytes in the ratio of 0.6 to 0.78, denied the past history of tuberculosis and hepatitis history. Admission examination: the end of sitting, shortness of breath, breathing 36 times / min, obvious cyanosis of the lips, liver - jugular vein reflux sign positive, tender sternum, lungs covered with wheeze, heart rate 107 beats / min, Unpredictable and pericardial frictional tone, the heart bound to bilateral enlargement, blood pressure 16 / 10.5kPa, hepatic ribs under 2.0cm. Spleen rib 2.5cm, quality, no tenderness, skin and mucous membrane no bleeding, both lower extremity no edema, Amazing and not swollen superficial lymph nodes. Blood tests showed: white blood cell count 4.7 × 10 ~ 9 / L, Hb141g / L, platelet count 240 × 10 ~ 9 / L, lymphocyte ratio 0.87; X-ray showed: increased heart shadow, pulmonary infiltrates with infection. Echocardiography showed a small amount of pericardial effusion, local pericardial thickening. B ultrasound shows: hepatosplenomegaly. Bone marrow routine examination showed that: significant proliferation of nucleated cells, lymphoid hyperplasia, the primary lymphocytes, the original