感染性心内膜炎368例临床分析  

Clinical characteristics of infective endocarditis： analysis of 368 cases

作　　者：王鹏[1] 卢静海[2] 王贺玲 于丽天[1] 谭慧琼[1] 熊长明 杨跃进[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院心内科,100037 [2]山东省东营市胜利石油管理局胜利医院心内科 [3]廊坊长征医院心内科

出　　处：《中华心血管病杂志》2014年第2期140-144,共5页Chinese Journal of Cardiology

摘　　要：目的 探讨近7年感染性心内膜炎（IE）患者的临床特征、基础心脏病及致病微生物特点及变迁.方法 对阜外心血管病医院2005年至2012年住院治疗的IE患者368例进行回顾性分析,着重分析其基础病因、致病微生物分布及临床转归情况.并对不同亚组的临床及流行病学特点进行对比和分析.结果 基础病因中风湿性心脏病占6.8％ （25/368）,先天性心脏病占31.8％（117/368）,心脏手术或介入检查及治疗术后被视为独立群组,占22.8％（84/368）,无基础心脏病的患者占14.1％（52/368）.血培养阳性率为46.2％（170/368）,其中草绿色链球菌仍然是最常见的致病菌占27.6％（47/170）,其次为凝固酶阴性葡萄球菌占15.9％（27/170）.外科手术及介入术后心内膜炎中凝固酶阴性葡萄球菌是最常见的致病菌占26.7％（12/45）.临床表现常见有发热（81.3％,299/368）和心脏杂音（78.2％,288/368）.心力衰竭是最常见的并发症（87.8％,323/368）,其次为栓塞并发症（16.0％）.298例（80.9％）的患者超声心动图呈现阳性发现,其中211例发现赘生物,与术中及病理发现吻合率高.住院病死率为6.7％,死亡及未愈者普遍表现为药物难以控制的心力衰竭及菌血症.亚组对照结果发现2009年后发病的IE亚组基础病因中外科及介入术后IE明显多于2009年前亚组（27.5％比19.2％）.人工瓣膜IE中葡萄球菌（尤其是凝固酶阴性葡萄球菌）明显高于自体瓣膜组（44.4％比19.8％）.结论 IE的流行病学特点及临床表现近年来发生了变化,先天性心脏病及心脏手术治疗后的比例明显升高,基础心脏病中风湿性心脏病所占比例呈进一步下降趋势,人工瓣膜IE致病菌中葡萄球菌及革兰阴性杆菌明显高于自体瓣膜IE.IE血培养阳性率低,超声心动图阳性表现成为最为重要的诊断依据.住院期间死亡患者多为内科治疗难以控制的心力衰竭或脓毒血症病例,�Objective This retrospective study is performed to analyze the epidemiological and clinical features of patients with infective endocarditis （ IE ） hospitalized in Fuwai Cardiovascular Hospital during the latest 7 years. Methods This retrospective study included a cohort of 368 infective endoearditis patients hospitalized in Fuwai Hospital form August 2005 to August 2012. Predisposing cardiac diseases, causative organisms, clinical features and outcomes were analyzed. Risk factors related to outcome including NYHA classes, causative organisms and complications, were evaluated. Results Among the IE patients, 6.8% （25/368） patients had rheumatic heart diseases 31.8% （117/368） had congenital heart diseases, 22. 8% （84/368） were post-PCI or operative endoearditis and IE developed in 14. 1% （52/368） patients without previous cardiac diseases. Blood culture positive rate was 46. 2% （ 170/368 ）. Streptococci viridians [27.6% （47/170）] were the most common causative organisms, followed by eoagulase-negative staphylococci [ 15.9% （27/170） ]. Fever and cardiac murmur were the most common clinical presentations. Congestive heart failure was the most common complication [ 87.8% （323/368） J. Systemic and pulmonary embolism occurred in 16. 0% patients, 80. 9% IE was detected by eehoeardiography. In-hospital mortality rate was 6.7% , mostly due to refraetory eongestive heart failure and sepsis. Subgroup analysis showed that incidence of post-PCI or operative endocarditis was significantly higher in IE patients hospitalized after 2009 compared to IE patients hospitalized before 2009 （ 27. 5% vs. 19. 2%, P 〈 0. 05 ）. Higher incidence of staphylococcal infection was evidenced in mechanical valves than in native valves（44. 4% vs. 19. 8%, P 〈 0. 05）. Conclusion During the past decade, there is a significant change on epidemiology and clinical features of IE in China. Incidence of post-surgical and interventional IE increased significantly. Staphylococcal and Gram negative bacilli infec

关 键 词：心内膜炎 细菌性 流行病学 症状和体征 

分 类 号：R542.41[医药卫生—心血管疾病]