超声心动图对感染性心内膜炎患者的赘生物及其他常见并发症的研究  

Vegetation and other common complications in patients with infective endocarditis by echocardiography

作　　者：吴伟春[1] 王浩[1] 赵星[1] 高一鸣[1] 张家芬[1] 霍顺伟[1] 涂大楼[1] 郑平[1] 王吴刚[1] 韩宁 

机构地区：[1]北京协和医学院中国医学科学院心血管病研究所阜外心血管病医院超声科,北京100037 [2]总装备部后勤部亚运村门诊部B超室

出　　处：《中华医学超声杂志（电子版）》2011年第3期51-54,共4页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的总结和探讨感染性心内膜炎患者的赘生物及其他常见并发症的超声心动图详细特征及其不足之处。方法选取2003～2008年在我院住院且确诊为感染性心内膜炎患者118例,所有患者均进行了手术和病理检查确诊。并将患者经胸超声心动图与手术、病理结果进行比较研究。结果在符合入选条件的118例感染性心内膜炎患者中,病理发现赘生物或菌落者78例,慢性瓣膜炎71例,黏液样变性13例。本组病例中,超声检查出赘生物大小2～26mm,1至多个,活动度主要为好,以强或中强回声,首先以左心房面受累;超声心动图对赘生物检出率为83.8%;并且经胸超声心动图的检出率随着赘生物增大和数量逐渐增加。超声对于赘生物形态描述主要为团块状、不均质样回声,而手术中常描述为菜花状、结节状。超声对损伤瓣膜的检出率达89.1%,对单纯主动脉瓣损伤的检出率最高;对于其他并发症的检出率如人工瓣瓣周漏、瓣膜脱垂、脓肿、假性动脉瘤、瓣叶穿孔分别为100%、95.0%、66.7%、66.7%及33.3%,虽然超声对瓣叶穿孔检出率最低,但其特异度高达99.1%,而敏感度仅为22.2%。结论超声心动图能够对大部分感染性心内膜炎患者的赘生物大小、数量及附着位置、损伤瓣叶及其常见并发症进行准确判断,但对瓣叶穿孔判断能力有待提高,对赘生物形态的描述有待与手术统一。Objective To summarize and assess the value and deficiencies of echocardiography in diagnosis of vegetation and other common complications in patients with infective endocarditis.Methods A group of consecutive patients with surgical and pathologically diagnosed as infective endocarditis were analyzed from 2003 to 2008 at Fuwai hospital.The results of echocardiography and surgery,pathological tests were compared.Results There were 118 patients with infective endocarditis.Pathological vegetations or bacterial colonies were detected in 78 patients;chronic valvular inflammation in 71 cases;mucoid degeneration in 13 cases.In this group of patients,the vegetation size was within a range of 2-26 mm,the number from 1 to 2 or 3.The activities were well with strong or moderately strong echo dense;most of vegetation were involved with left atrial chambers.The detection rate of vegetations by echocardiography was about 52.5%,and the diagnose accordance rate with surgery was approximately 83.8%.The coincidence rate with the surgical results and transthoracic echocardiography gradually increased along with increased vegetation size and number.Vegetation patterns were usually described as cloddy and heterogeneous echo-like images by echocardiography,but the cauliflower-like or nodular images were shown by surgery.The diagnose accordance rate of the valve injury was 89.1%,and there was the highest detection rate of only aortic valve damage;In other complications,prosthetic valve leakage,prolapose,abscess,pseudoaneurysm,perforation the detection rate for others were 100%,95.0%,66.7%,66.7% and 33.3%,respectively.Compared with other infective endocarditis complications,the perforation of the valve leaflets detected was lowest,but specificity was 99.1%,while the sensitivity was only 22.2%.Conclusion Echocardiography could accurately assess the complications like vegetation size,number and attachment location,damage of valve leaflets in the majority of patients with infective endocarditis,but the assessment ability of the valve leafl

关 键 词：超声心动描记术 感染性心内膜炎 并发症 

分 类 号：R542.4[医药卫生—心血管疾病]