tbuckley/cabot-search huggingface dataset:
Trends in patient misperception and decisional regret during treatment for advanced cancer: A prospective study.
Authors: Eric James Miller, Rushad Patell, David Johnson Einstein, Jennifer Halleck, Laura Dodge, Mary K. Buss
Journal: Journal of Clinical Oncology (2020)

e24190 Background: Cancer patients receiving palliative therapy often misperceive the likelihood of benefits and toxicity. Change in misperception during treatment and decisional regret after has not been studied. We assessed shifts in perception of treatment outcomes and decisional regret after treatment in a single-center prospective study. Methods: We enrolled patients with advanced solid cancer starting palliative intent treatment. At baseline, both patients and their treating physicians were asked about their perceived likelihood of treatment response, symptom palliation, survival benefit, and treatment toxicity on scale of 0-100% at start of treatment and at follow-up. The Signed Rank tested whether patient perception changed significantly over time. After treatment, patients alive and not in hospice were asked about their decision to undergo treatment. Results: Of 122 patients with baseline estimates, 65% completed at least one follow-up survey while undergoing treatment. At enrollment, respondents’ mean age was 65 years (range: 32–89); 54% were male. Compared to baseline, there was no change in patients’ perceptions of treatment response, survival benefit, toxicity (all P≥0.52) at follow-up; a trend toward change in perceived curative potential (P = 0.06); an increase (of 7 points) of perceived likelihood of symptom relief (P = 0.04). Perceived likelihood of treatment response and symptom relief increased (both P &lt; 0.03) among patients whose baseline estimates of treatment response were lower than or similar to their physicians’ estimates. Conversely, perceived likelihood of treatment response (P = 0.01) and curative potential (P = 0.02) decreased among patients with more optimistic estimates than their physicians’. Of the surviving 63 patients, 33 (52%) completed the end of treatment survey, 24 were unreachable and 6 declined. Median time of survey response was at 41.2 weeks (IQR: 36.4 – 47.9). Nearly all (95%) agreed that treatment was the right decision. None regretted their choice; 79% agreed they would make the same choice if they had to do it again; 12% agreed that treatment did them a lot of harm. Conclusions: Patients’ perceptions of treatment response converged during therapy as compared to their physicians at baseline. Of surviving patients surveyed, none regretted their decision to receive palliative cancer treatment. Treatment expectations evolve over time, highlighting opportunities for enhanced communication and patient education beyond initial consent procedures.
女性尿失禁的分类及其发病机制
Authors: 宋岩峰
Journal: BMJ (2005)

按照国际尿控协会(International Continence Society,ICS)的定义,尿失禁(urinary incontinence,UI)是指客观存在的不自主性尿液排出,并对社会活动和个人卫生造成不良影响.女性尿失禁是妇女常见病,其发生随妇女年龄的增加而增加,随着现代社会人口日益老龄化,发病率不断上升.国际流行病学研究显示,女性尿失禁已成为威胁妇女身心健康的5种主要慢性疾病之一,其医疗费用已超过乳腺癌、骨质疏松和忧郁症等,严重影响妇女的身心健康.我国是一个人口大国,从20世纪下半叶开始,人口老龄化日趋明显,随着老年及高龄老年人口的增加,女性中患妇科泌尿系统疾病的人数将越来越多,加强对其分类及发病机制的认识将有助于更准确的认识和防治该疾病。
Risk factors of chronic kidney disease in elderly patients with type 2 diabetes mellitus
Authors: Yao Cui, Mingzhao Qin
Journal: BMJ (2014)

Objective
To investigate clinical characteristics and risk factors in elderly patients with type 2 diabetes mellitus (T2DM) complicated with chronic kidney disease (CKD).


Methods
Two hundred and two T2DM patients aged ≥60 y admitted in Tongren Hospital from August 2009 to February 2012 were enrolled in the study, including 64 cases complicated with CKD(CKD group)and 138 cases without CKD(non-CKD group). Hemoglobin (Hgb), albumin(ALB), glycated hemoglobin A1C (HbA1c), fasting plasma glucose(FBG), postprandial glucose (PBG), serum creatinine (Scr), blood urea nitrogen (BUN), uric acid (UA), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C) were measured and ratio of urinary albumin to creatinine (UAER/CR) were calculated, ankle brachial index (ABI) and ambulatory blood pressure was examined.


Results
The duration of diabetes in CKD group was longer than that in non-CKD group[(13±11) vs. (10±7) y, t=2.35, P 0.05). Logistic regression analysis showed that ALB, TG and UAER/CR were the independent risk factors of CKD in T2DM patients(OR: 0.79, 3.63 and 1.04, 95%CI: 0.62-1.01, 1.45-9.01 and 1.00-1.08). Spearman correlation analysis demonstrated that eGFR was positively associated with Hgb, ALB, ABI(r=0.38, 0.33 and 0.28, all P<0.01), negatively associated with age, BUN, Cr, UA, TG, UAER/CR, 24 hSBP and PP in all diabetes patients(r=-0.32, -0.63, -0.89, -0.34, -0.18, -0.65, -0.16 and -0.248, all P<0.01).


Conclusions
ALB, TG , UAER/CR are the independent risk factors of chronic kidney disease in elderly patients with type 2 diabetes mellitus.


Key words: 
Diabetes mellitus, type 2; Aged; Kidney diseases, chronic; Cross-sectional studies
The incidence of myelodysplastic syndrome in patients receiving poly-ADP ribose polymerase inhibitors for treatment of solid tumors: A meta-analysis.
Authors: Roni Nitecki, Allison Ann Gockley, Jessica Lauren Floyd, Robert L. Coleman, Alexander Melamed, Jose Alejandro Rauh-Hain
Journal: Journal of Clinical Oncology (2020)

3641 Background: Clinical trials have reported improved outcomes with PARPi (poly [adenosine diphosphate–ribose]-ADP polymerase inhibitor) therapy in ovarian, breast, pancreatic and lung cancers. There is concern that PARPi therapy may cause myelodysplastic syndrome (MDS). In this meta-analysis we seek to quantify the risk of MDS among patients treated with PARPi for solid tumor malignancies. Methods: We searched Medline, Embase, and Cochrane databases (up to January 6, 2020) to abstract randomized controlled trials that include a PARPi in the experimental arm in solid tumors. Combinations included PARPi versus (vs.) placebo, PARPi vs. cytotoxic treatment, and PARPi with cytotoxic treatment vs. cytotoxic treatment. We used to time-to-event curves to estimate person-time and calculated the incidence of MDS among all studies. We used random-effects Poisson regression models to estimate pooled incidence risk ratio (RR) for developing MDS. Results: We identified 14 studies, 10 in ovarian, 3 in breast, and 1 in pancreatic cancer patients. Of 5,646 patients, 62.3% received a PARPi alone or in combination with chemotherapy or bevacizumab, and 37.8% received treatment consisting of placebo alone or with chemotherapy or bevacizumab. PARPi were investigated as an upfront treatment in 2,827 patients, and as treatment for recurrence in 2,819 patients. The incidence of MDS was 6.73 cases vs. 3.85 per 1000 person-years in patients receiving PARPi as compared to control corresponding to a 3-year cumulative incidence of 2.0% and 1.1%. Accounting for intra-study clustering, PARPi use was associated with a 60% increase in risk (incidence RR 1.60, 95% Confidence Interval [CI] 0.89-2.87) of MDS compared to control. In the upfront setting, patients randomized to PARPi were twice as likely to develop MDS (RR 2.08, 95%, CI 1.39-3.64). Among patients treated for recurrence, the risk of MDS appeared to be similar among patient randomized to PARPi or control treatment (RR 1.13, 95% CI 0.35-3.64). In studies that compared PARPi in combination with other cytotoxic treatment vs. cytotoxic treatment alone, PARPi was associated with a large risk of MDS (RR 5.08, 95% CI 1.36-19.03). Conclusions: In pooled estimates from randomized controlled trials in solid tumors PARPi treatment appears to be associated with an increased incidence of MDS particularly in the upfront setting and when combined with cytotoxic treatment. Despite pooling 14 randomized trials our estimates remain imprecise due to the rarity of MDS.
Establishment and application of general practitioners two-way referral platform between a comprehensive teaching hospital and community health centers
Authors: Wenchang Li, Wenjuan Shi, Shanzhu Zhu, Zhigang Pan, Min Ge, Jian Wang, Yao Shen, Jian Zou, Liyang Zhang, Yao Liu
Journal: BMJ (2015)

Objective
To establish a general practitioners two-way referral platform (GPTRP) between a comprehensive teaching hospital and community health centers and to assess its feasibility.


Methods
GPTRP was established between the department of general practice, Zhongshan Hospital, Fudan University and three community health service centers of Changning District (Hongqiao, Xinhua, Zhou Jiaqiao) from November 2012 to November 2013. The rationality, disease categories and purpose of referrals were analyzed. A questionnaire was designed to investigate the degree of satisfaction of patients.


Results
During this period 65 patients/times used the GPTRP for referral, 78% (51/65) of which was reasonable. The first five diseases of referral were coronary heart disease (7/65), chest tightness of unknown origin (7/65), diabetes (5/65), hypertension (4/65), hematuria of unknown origin (3/65). The purposes of referrals were for consultation of treatment protocol (22/65), diagnosis (20/65), further examination (17/65), admission requirement (3/65), health consultation (2/65) and postoperative follow-up (1/65). The satisfaction of patients was 100%(65/65).


Conclusion
The general practitioners referral platform is feasible for two-way referral system between tertiary hospital and community health service centers.


Key words: 
Patient transfer; Multi-institutional systems; Hospitals, general; Community health services
Analysis of long-term abstinence rate among smokers at a smoking cessation clinic at a smoke-free hospital
Authors: Linyi Rong, Fengxi Bai, Xiadan Wang
Journal: BMJ (2014)

A total of 133 smokers visiting our smoking cessation clinic from February 2009 to September 2010 were studied. The data were collected during initial assessments and over a follow-up period of 24 months. Long-term abstinence rate was observed. And logistic regression was employed to identify the independent predictors of successful quitting. There were 132 males and 1 female with a mean age of 47 years. They smoked an average of 26 cigarettes per day. The mean duration of smoking was 25 years. Among them, 57 smokers (42.9%) were severely nicotine dependent and 76 smokers (57.1%) were followed up for 24 months. And 20 smokers (26.3%) maintained 24 month abstinence. The predictor of avoiding relapse was immediate family members being nonsmokers.


Key words: 
Smoking cessation; Treatment outcome
癌症康复
Authors: 谭维溢
Journal: BMJ (2005)

癌症治疗后获得根治或带癌生存的患者往往存在程度不同的身心功能障碍,迫切需要进行康复治疗,以改善身心功能,增进身体健康,提高生存质量.因此癌症康复日益受到人们的重视,成为癌症防治和康复医学的一个重要组成部分[1-4].癌症康复的目的、任务和方法与一般伤病的康复基本相同,但具有癌症的特点。
内镜黏膜下剥离术治疗消化道黏膜和黏膜下病变分析
Authors: 王福生, 唐光华, 孙达龙, 乐红琴, 单际平
Journal: BMJ (2012)

采用内镜黏膜下剥离术( ESD)治疗经胃肠镜检查发现消化道黏膜和黏膜下病变患者68例.ESD手术时间50～ 160 min.病变直径1.0～5.5 cm,病变部位于食管53例,胃12例,十二指肠1例,结肠2例.所有病例均无大量出血、穿孔等严重并发症,2例发生术后食管狭窄予扩张治疗.ESD术后随访1～16个月,创面愈合良好,均未见肿瘤残留和复发。
Application of ultrasound-guided thoracic paravertebral nerve block in percutaneous kyphoplasty
Authors: Shaoqi He, Haijie Xia, Chengxuan Tang, Ansheng Wu, Xiaojun Tang
Journal: BMJ (2018)

From January 2016 to June 2017, 68 patients with thoracic osteoporotic compression fractures were treated with percutaneous kyphoplasty, including 31 cases with ultrasound-guided thoracic paravertebral nerve block (group A) and 37 cases with local anesthesia (group B). The duration of analgesia in group A was longer than that in group B (P 0.05). The post-operative VAS scores was significantly lower than those of pre-operation in both groups (P 0.05). No cardiovascular and cerebrovascular adverse reactions occurred in both groups. Ultrasound-guided thoracic paravertebral nerve block is a safe and effective method used in percutaneous kyphoplasty.


Key words: 
Nerve block; Ultrasonography; Vertebroplasty; Thoracic paravertebral
Analysis of sexual life quality in postmenopausal women with cystocele or stress urinary incontinence before and after treatment
Authors: Wenhui Deng, Yi Zhang, Qiubo Lyu, Fenghua Wei, Guihua Shen
Journal: BMJ (2010)

To assess the effect of cystocele(anterior pelvic organ prolapse, AOP)or stress urinary incontinence (SUI) on sex life quality in postmenopausal women under 65 years and observe the change of sex life quality after individualized surgical repair and tension-free vaginal tape-obturator (TVT-O). The postmenopausal patients aged 48 to 65 years at Beijing Hospital were observed from June 2008 to December 2010. They were divided into 3 groups of AOP (n=52), SUI (n=30) and control without gynecological and urinary system diseases on routine examinations (n=25). Their sexual life qualities were evaluated by pelvic organ prolapse/urinary incontinence sexual questionnaire(PISQ-31)with 31 items before treatment and at 3, 6 months after surgical treatment in AOP and SUI groups. The sexual life quality scores were significantly lower in SUI group than those in control and AOP groups(P<0.01). It significantly increased after TVT-O treatment(P<0.01). There was no significant difference after treatment when compared with that before treatment in POP group.


Key words: 
Urinary incontinence, urge; Organ prolapse
Alterations of DNA damage repair genes in Chinese colorectal cancer patients.
Authors: Wenliang Li, Zhu Zhu, Ning Xu, Wei Huang, Junping Shi, Jiaochun Shi, Weifeng Wang, Samuel J Klempner, Juan Zhao, Jialiang Gan
Journal: Journal of Clinical Oncology (2020)

e16121 Background: Colorectal cancer (CRC) is the second most common cancer in women and third in men. DNA damage repair (DDR) deficiency has emerged as a predictive biomarker for chemotherapy, PARP and immune checkpoint inhibitors. However, comprehensive molecular characteristics of DDR variants in Chinese CRC patients is lacking. Methods: Formalin fixed, paraffin embedded (FFPE) tumor tissues and matched blood samples were collected for targeted next-generation sequencing (NGS) assay. The testing was carried out in a College of American Pathologists (CAP) accredited and Clinical Laboratory Improvement Amendments (CLIA) certified laboratory. Alterations of six functional gene sets involved in DDR pathways: homologous recombination (HR), mismatch repair (MMR), base excision repair (BER), nonhomologous end-joining (NHEJ), checkpoint factors (CPF) and Fanconi anemia (FA) were analyzed. The association of DDR gene mutations with TMB/MSI was assessed. Results: In total, 319 CRC patients were recruited, 127 female and 192 male with a median age of 59 (range 23-92). Over one third (36%,115/319) patients had at least one mutation in DDR genes. Mutation rates varied in different DDR pathway: HR (20.7%), CPF (15.1%), FA (11.3%), MMR (10.3%), BER (8.8%), and NHEJ (5.3%). The most frequently mutated DDR genes were ARID1A (13.4%), ATM (10.2%), BRCA2 (6.8%), MLH1 (5.6%), MSH6 (5.6%), POLE (5.0%). Germline mutations in MLH1 (2.5%), BRCA2 (1.2%), MSH2 (0.9%), MSH6 (0.9%), FANCA (0.9%), ATM (0.6%), BRCA1 (0.3%), and CHEK2 (0.3%) were detected in 24 patients. DDR variations were enriched in the right-side CRC compared to the left side CRC (50% vs. 32.8%, p= 0.024). Early stage (I-II) harbored more DDR variations. 20.1% of patients had high TMB (≥10 muts/Mb) with a median of 51 muts/Mb (10-326.7 mus/Mb). Patients with DDR mutations had a significantly higher TMB than patients with wild type DDR (8.5 vs. 4.6 muts/Mb, p&lt; 0.001). All CRC tumors with high MSI harbored DDR mutations. Importantly, the mutations in “HM” (HR/MMR), but not BER/CPF/NHEJ/FA mutations, were significantly correlated with high MSI ( p&lt; 0.001). Conclusions: DDR gene alterations occurred in 36% of Chinese CRC patients and were enriched in right sided tumors. DDR pathway alterations are relatively frequent in CRC and consideration for biomarker-enriched clinical trials with PARP, immune checkpoint inhibitors, and novel combinations are warranted.
Study of anlotinib combined with icotinib as the first-line treatment in non-small cell lung cancer (NSCLC) patients harboring activating EGFR mutations (ALTER-L004).
Authors: Dingzhi Huang, Diansheng Zhong, Cuiying Zhang, Yan Zhang, Yanhong Shang, Liuchun Wang
Journal: Journal of Clinical Oncology (2020)

9573 Background: Anti-angiogenic monoclonal antibodies plus EGFR TKIs have previously shown to prolong PFS in patients with EGFR-mutated NSCLC (JO25567 and NEJ026). Unlike bevacizumab, anlotinib is more convenient with orally administered and can inhibit more targets. Monotherapy using anlotinib has significantly prolonged median PFS and OS compared with the placebo values for third-line treatment or beyond in advanced NSCLC. We conducted a study to investigate the activity of anlotinb combined with icotinib, an oral EGFR TKI. Methods: This is a prospective, single-arm, multicenter clinical trial. Patients with locally advanced and/or metastatic IIIB, IIIC or IV non-squamous NSCLC are enrolled. Patients with EGFR exon 19 deletion and/or exon 21 L858R mutation who have not received prior therapies are eligible. The regimen consists of anlotinib (12 mg p.o, qd, day 1 to 14 every 21-day cycle) and icotinib (125mg p.o, tid). The primary endpoint is PFS. Secondary endpoints are OS, ORR, DCR and safety. Results: Between Jul 2018 and Dec 2019, 35 patients were enrolled in five centers and treated with anlotinb and icotinib. At data cutoff (Jan 7, 2020), patients were followed up for a median of 6.01 months.32 tumors were analyzed with 30 evaluable. Preliminary efficacy results: ORR was 59% (0 CR, 19 PR), DCR was 88% (0 CR, 19 PR, 9 SD). 26 patients are still receiving treatment and the longest exposure was 14 cycles. 10 (67%) of 15 patients with exon 19 deletions and 9 (53%) of 17 patients with L858R mutations achieved an objective response. 18 patients harbored aberrations in additional oncogenic drivers (PIK3CA or AKT1) and/or tumor suppressors (TP53, RB1, and PTEN) with an ORR of 72%. Upon analyses, AEs were observed in 97% (34/35) of patients. No Gr 5 AEs were reported. The most common Grade 3 AEs were hypertension (6 [ 17% ]), hypertriglyceridemia (2 [6% ]), diarrhea (1 [ 3% ]), hyperuricemia (1 [ 3% ]), hand and foot skin reaction (1 [3%]), asthenia (1 [3%]), and acute coronary syndrome (1 [ 3% ]). Hypertriglyceridemia was the only grade 4 AE (2 [ 6% ]). Three patients had to adjust treatment dosage. Conclusions: The strategy of anlotinib plus icotinib showed encouraging efficacy for previously untreated, EGFR-mutated advanced NSCLC patients. The combination was well tolerated and the AEs were manageable. The follow-up time is not sufficient and the PFS and OS outcomes need further evaluation. Clinical trial information: NCT03736837 .
Use of simulation for training family caregivers of patients receiving radiation therapy.
Authors: Susan R Mazanec, Eric Blackstone, Jennifer Anne Dorth, Kate Sandstrom, Celeste Alfes, Nicholas K Schiltz, Mendel E Singer, Rod Rezaee, Barbara J. Daly
Journal: Journal of Clinical Oncology (2020)

TPS12129 Background: Positive treatment outcomes and avoidance of complications are dependent to a large extent on the care provided by family members. However, family caregivers report feeling unprepared to assume the multiple, complex tasks of caregiving, including tracheostomy care, tube feedings, wound and colostomy care, pain management, and emotional support. Despite being a critical extension of the oncology healthcare team, training of caregivers to manage symptoms, deal with communication issues with the care recipients, and take care of their own physical and emotional health as caregivers, is not integrated into clinical practice. The purpose of this clinical trial is to measure the effect of a psychoeducational caregiver intervention that incorporates simulation techniques focused on skill development to improve caregiver and patient outcomes. Simulation, commonly used in training healthcare professionals, is a form of experiential learning that creates events or situations to mimic clinical situations. Use of simulation for skills training in family caregivers of patients with cancer is rarely studied. Methods: This two-group, randomized clinical trial, which opened to accrual in December 2019, will recruit 180 caregivers from University Hospitals Seidman Cancer Center. Patients must be receiving radiation therapy for a diagnosis of stage I - III cancers of the rectum, anus, and esophagus; stage III NSCLC; or stage I – IV A/B head/neck cancer. Adult caregivers must be identified by the patient as their primary caregiver, who is providing daily assistance and/or emotional support. The intervention involves three in-person, one-on-one sessions during radiation treatments. The control group is usual care. Data will be collected at baseline, at the end of radiation treatment, and 4 and 20 weeks post-radiation treatment. The primary outcome is caregiver anxiety at 20 weeks postradiation treatment. Other caregiver outcomes include depression, health-related quality of life [HRQOL], and fatigue. Patient outcomes (HRQOL and interrupted treatment course) and healthcare utilization outcomes (unplanned hospital admission, emergency room visits, and use of intravenous fluids) will be measured. The analysis will consist of linear mixed model repeated measures, mediation and moderation tests, and Poisson regression methods. Clinical trial information: NCT04055948 .
Management and outcomes of patients with ST-elevation myocardial infarction in Liaoning province
Authors: Bo Zhang, Xu-chen Zhou, Jun Liu, Hao Zhu, Yu-jiao Sun, Li-na Ren, Yuan Gao, Yu-ze Li, Guo-xian Qi
Journal: BMJ (2012)

Objective To analyze the management and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) in Liaoning province.Methods The data were collected from a prospective and multicenter registry study including 8 tertiary hospitals and 12 secondary hospitals in Liaoning province.Total 1429 patients with acute STEMI admitted to hospitals from June 2009 to June 2010 were included in the study.A unified follow-up questionnaire was applied on patient discharged.Results The average age of patients was (63 ± 13)years.37.4％ of patients recognized the disease as heart disease and 39.7％ were transported by emergency ambulance with a median symptom-to-door time of 150 min.52.9％ patients underwent emergency reperfusion therapy,including fibrinolytic therapy (24.4％) and primary percutaneous coronary intervention (PCI,28.1％).The in-hospital treatment included aspirin (99.6％),clopidogrel (81.9％),statins (90.1％),low molecular weight heparin (89.5％),β-blocker (66.0％),angiotensin converting enzyme inhibitor (ACEI)/ angiotensin receptor blocker (ARB)(66.6％).The in-hospital mortality was 10.7％ ; the mortality in females was higher than that in males (18.3％ vs.7.9％,P ＜ 0.01) and the mortality in older patients (≥ 65 years) was higher than that in younger patients (＜65 years)(17.0％ vs.5.2％,P ＜0.01).The follow-up treatment included:aspirin (81.1％),clopidogrel (45.0％),statins (61.0％),β-blocker (48.3％),ACEI/ARB (42.4％).The follow-up mortality was 5.0％ after hospital discharge.Conclusions Longer pre-hospital delay is commonly seen in STEMI patients.There is still certain gap of emergency reperfusion therapy and the evidence-based medication with related clinical guidelines of STEMI management in Liaoning.

Key words: 
Myocardial infarction; Myocardial reperfusion; Therapy; Cross-sectional studies
Neuroleptic strategies for terminal agitation in patients with cancer and delirium at an acute palliative care unit: a single-centre, double-blind, parallel-group, randomised trial
Authors: David Hui, Allison De La Rosa, Annie Wilson, Thuc Nguyen, Jimin Wu, Marvin Delgado-Guay, Ahsan Azhar, Joseph Arthur, Daniel Epner, Ali Haider, Maxine De La Cruz, Yvonne Heung, Kimberson Tanco, Shalini Dalal, Akhila Reddy, Janet Williams, Sapna Amin, Terri S Armstrong, William Breitbart, Eduardo Bruera
Journal: The Lancet Oncology (2020)
以心包填塞为首发症状的系统性红斑狼疮三例
Authors: 周滨, 张奉春
Journal: BMJ (2007)

20年间在本院住院的2904例系统性红斑狼疮患者中,有3例以心包填塞为首发症状,均为中年女性,大量心包积液,蛋白含量高,病理为慢性非特异性炎症,糖皮质激素及免疫抑制剂治疗反应良好,未复发心包填塞.对以心包填塞为首发症状的患者,应考虑到系统性红斑狼疮的可能性,心包积液的检查对于明确诊断及治疗具有重要意义。