中国标准和Duke标准诊断感染性心内膜炎比较研究  

Comparing the diagnostic value of the Chinese criteria and the Duke criteria for infective endocarditis in medical practice

作　　者：王国华[1] 吴弘[1] 秦永文[1] 温昌霖[1] 

机构地区：[1]第二军医大学长海医院心内科,上海市200433

出　　处：《中国心血管病研究》2007年第7期481-484,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的比较中国试行标准和修订的Duke标准对感染性心内膜炎的诊断价值,讨论感染性心内膜炎的临床特征。方法经病理确诊的感染性心内膜炎患者65例,平均年龄33岁,以修订的Duke标准和中国试行标准对其进行诊断评价,比较两种诊断标准对感染性心内膜炎诊断的敏感性。结果做2次以上血培养的40例(61.5%),其中血培养阳性并为相同病原菌的16例(24.6%),超声心动图发现心内膜受累征象49例(75.4%),有基础心脏病者61例(93.8%),胃肠外药物滥用者2例(3.1%),病变累及左心58例(89.2%),累及右心5例(7.7%),累及全心2例(3.1%)。按修订的Duke标准,符合临床确诊的15例(23.1%),按中国试行标准,符合临床确诊的41例(63.1%),两种结果的差异有统计学意义(χ2=21.21,P<0.01)。结论中国试行标准明显优于修订的Duke标准,采用经胸超声心动图结果作为心内膜受累证据和2项临床次要指标作为临床确诊依据,提高了感染性心内膜炎诊断的敏感性,在诊断感染性心内膜炎中更有价值。Objective The aim of our study was to compare the value of the Chinese diagnostic criteria and the Duke diagnostic criteria for infective endocarditis （IE） in medical practice. Methods We determined the sensitivity predictive value of these two sets of diagnostic criteria in 65 patients with established infective endocarditis who were operated in our hospital. Results The patients essentially had underlying heart disease（93.8% ）. Microbial documentation included mainly gram-positive cocci （24.6%）. With evidencese of transthoracic echocardiography （TFE）as a major criterion and two minor criteria, the sensitivities of the Chinese diagnostic criteria and the Duke criteria were 63.1% and 23.1%, respectively. Conclusion The Chinese diagnostic criteria seemed to be more useful for the management of patients with infective endocarditis followed in medical practice.

关 键 词：心内膜炎 诊断口 

分 类 号：R542.41[医药卫生—心血管疾病]