感染性心内膜炎23例误诊分析并文献复习  

Misdiagnosis of Infective Endocarditis: 23 Case Reports and Literature Review

作　　者：于华[1] 陈金平 吴咏静 YU Hua;CHEN Jin-ping;WU Yong-jing(Department of Geriatrics,the First Hospital of Shijiazhuang City,Shijiazhuang,Hebei 050011,China)

机构地区：[1]石家庄市第一医院老年病科,石家庄050011

出　　处：《临床误诊误治》2018年第8期1-4,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨感染性心内膜炎(infective endocarditis,IE)的临床特点、诊治措施、误诊原因及防范措施。方法对23例IE误诊病例的临床资料进行回顾性分析,并复习相关文献。结果 23例中16例有心脏基础疾病,以发热、心脏听诊杂音、心功能不全及贫血等为主要临床表现,查血白细胞升高12例,不同程度贫血10例,D二聚体升高9例,氨基末端B型尿钠肽前体(NT-proBNP)升高8例,红细胞沉降率增快及C反应蛋白升高各5例。镜下蛋白尿13例,镜下血尿6例。超声心动图检查提示心脏赘生物16例,心脏不同程度扩大12例。血培养阳性15例。误诊为急性心肌梗死8例,心力衰竭7例,上呼吸道感染4例,风湿性关节炎3例,化脓性脑膜炎1例。误诊时间2~5 d。23例按误诊疾病予对症治疗病情无好转,后经会诊或上级医生查房,结合患者临床表现及实验室、超声心动图、血培养等检查结果,确诊为IE。予敏感抗生素及手术治疗,均病情好转出院。结论临床表现不典型IE患者易误诊。临床遇及类似本文患者时应详细询问病史,仔细查体,动态观察心脏杂音变化,并及时行血培养及心脏彩色多普勒超声等检查,以减少或避免IE误诊误治。Objective To explore the clinical characteristics,diagnosis and treatment,causes of misdiagnosis and preventive measures of infective endocarditis(IE).Methods Clinical data of 23 misdiagnosed cases of IE were analyzed retrospectively,and related literature was reviewed.Results Of all 23 cases,16 cases had basic heart disease,with fever,heart murmur,cardiac insufficiency and anemia as the main clinical manifestations.In addition,blood tests results showed that there were 12 cases with an elevated number of blood leukocytes,10 with varying degree of anemia,9 with elevated D-dimer,8 with increased N-terminal pro-B-type natriuretic peptide(NT-proBNP),5 with accelerated erythrocyte sedimentation rate and 5 with elevated C-reactive protein.There were 13 cases of proteinuria and 6 cases of hematuria under microscope.Echocardiography revealed 16 cases of cardiac neoplasms and 12 cases of enlarged heart to varying degrees.Moreover,positive blood culture was found in 15 cases.The condition was misdiagnosed as acute myocardial infarction in 8 cases,heart failure in 7,upper respiratory tract infection in 4,rheumatoid arthritis in 3 and purulent meningitis in 1.The duration of misdiagnosis was 2-5 d.The disease was not improved in all 23 patients after symptomatic treatment according to the misdiagnosed disease.After the consultation or check-up by superior doctors,the diagnosis of IE was confirmed based on the clinical manifestations and test results,including laboratory test,echocardiography,and blood culture.All the patients were treated with sensitive antibiotics and surgical treatment and discharged at stable conditions.Conclusion IE patients with atypical clinical manifestations are easily misdiagnosed.For those patients in clinical practice,clinical history should be collected in detail,in addition to careful physical examination,dynamic observation of heart murmur,and timely examination of blood culture and color Doppler ultrasound,in order to reduce or avoid misdiagnosis and mistreatment of IE.

关 键 词：心内膜炎 误诊 心肌梗死 心力衰竭 

分 类 号：R542.41[医药卫生—心血管疾病]