感染性心内膜炎97例临床分析  

Clinical analysis of infective endocarditis： a report of 97 cases

作　　者：朱跃红[2] 陈沛冬[1] 陈晨[1] 虞胜镭[1] 翁心华[1] 陈澍[1] 

机构地区：[1]复旦大学附属华山医院感染科,上海200040 [2]常熟市第二人民医院,215500

出　　处：《中华传染病杂志》2012年第1期24-28,共5页Chinese Journal of Infectious Diseases

摘　　要：目的了解近年来感染性心内膜炎（IE）的临床特点变化。方法回顾性分析华山医院近10年收治的97例IE患者的临床资料，包括发病年龄、易感因素、临床表现、血培养及超声心动图检查。计量数值如患者发病年龄等以算术平均数±标准差表示，病例阳性数以百分比表示，对比分析采用Fisher确切概率法。结果97例IE患者平均年龄（49±17）岁，有基础心脏病73例，占75．3％；前三位是风湿性心脏病27例（27．8％）、先天性心脏病23例（23．7％）、特发性二尖瓣脱垂18例（18．6％）。临床表现为发热96例（99．0％）、心脏杂音93例（95．9％）、贫血82例（84．5％）。血液细菌培养阳性66例（68．0％），其中草绿色链球菌28株（42．4％），仍为主要致病菌，且全部发生于自然瓣膜心内膜炎患者中；葡萄球菌18株（27．3％），金黄色葡萄球菌10株（15．2%），有3株为耐甲氧西林金黄色葡萄球菌（MRSA），凝固酶阴性葡萄球菌8株（12．1％），有2株为耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）；鲍曼不动杆菌、嗜麦芽窄食单胞菌等耐药性强的病原菌各1株。超声心动图赘生物检出79例，占81．4％，其中右心赘生物9例，病原主要为葡萄球菌。结论IE患者临床表现、易感因素、致病菌发生了变化，多次血培养及超声心动图检查有助于诊断。Objective To analyse the clinical feature of infective endocarditis （IE） in recent years. Methods Clinical profiles including age of onset, predisposing factor, clinical manifestation, blood culture and ultrasonic cardio gram （UCG） of 97 cases from Huashan Hospital in the recent 10 years were collected and analyzed retrospectively. Descriptive data were represented as mean _--＋_ standard deviation form. Positive rate was represented as percentage form. Fisher＇s exact test were used to determine two groups＇ comparison. Results The mean age of the population was （49 ± 17） years. Seventy-three patients （75. 3%） had background heart disease, the top 3 of which was rheumatic heart disease in 27 patients （27.8%）, congenital heart disease in 23 patients （23.7%） and idiopathic mitral valve prolapse in 18 patients （18.6% ）. The most common clinical manifestation were fever （99.0%）, murmurs （95.9%） and anemia （84.5%）. Sixty-six patients （68.0%） had positive result of blood cultures. Streptococcus viridans, which was found in 28 patients with native valve endocarditis （42.4%）, was still the most common pathogen. Staphylococcus, which was found in 18 patients （27.3%）, had an elevated ratio. Staphylococcus aureus was found in 10 patients （15.2%） and 3 of which were MRSA. Coagulase-negative staphylococcus was found in 8 patients （12.1%） and 2 of which were MRCNS. Drug-resistant bacteria was increased and pathogens were varied. Vegetations were found in 79 patients （81. 4%） by UCG. Conclusions Clinical manifestation, predisposing factor and pathogen have changed in IE patients. Attaching importance to physical examination, multiple-time blood culture and UCG helps the diagnose of IE.

关 键 词：心内膜炎 细菌性 发热 心脏杂音 链球菌 草绿色 

分 类 号：R542.41[医药卫生—心血管疾病]