血液透析患者并发感染性心内膜炎的临床特征分析  

Clinical characteristics of infective endocarditis in hemodialysis patients

作　　者：沈维[1] 陈万远[2] 俞琦[3] 李一文[1] SHEN Wei;CHEN Wanyuan;YU Qi(Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)肾脏病科,杭州310014 [2]浙江省人民医院(杭州医学院附属人民医院)病理科,杭州310014 [3]黄岩中医院血透中心

出　　处：《浙江医学》2019年第10期1045-1048,共4页Zhejiang Medical Journal

基　　金：浙江省自然科学基金资助项目(LY19H050002);浙江省医药卫生科技计划项目(2014KYA018;2015KYB035)

摘　　要：目的分析血液透析(HD)患者并发感染性心内膜炎(IE)的临床特征。方法选取IE患者52例,其中确诊慢性肾脏病5期且行维持性HD时间超过3个月以上的IE患者9例(HD组),其余肾功能正常的IE患者43例(Non HD组)。回顾患者临床资料并对比分析两组患者的临床特征。结果两组患者性别、年龄等一般资料比较差异均无统计学意义(均P>0.05),入院时血WBC、Hb、C反应蛋白、血清白蛋白水平比较差异均有统计学意义(均P<0.05)。HD组患者血葡萄球菌培养阳性率高于Non HD组(66.7%vs 11.6%,P<0.05)。HD组患者住院期间心力衰竭发生率高于Non HD组(66.7%vs 23.3%,P<0.05),院内病死率高于Non HD组(33.3%vs 4.7%,P<0.05)。结论 HD患者合并IE的临床症状不典型,多由于葡萄球菌感染引起,受累心脏瓣膜主要为二尖瓣及主动脉瓣,易发心力衰竭,病死率高,应及时行心脏超声检查,并予积极有效的抗生素治疗或手术处理。Objective To analyze the clinical characteristics of infective endocarditis(IE) in hemodialysis(HD) patients. Methods Fifty two patients with IE were enrolled, including 9 patients with stage 5 chronic kidney disease who underwent maintained HD for more than 3 months (HD group), and 43 patients with normal renal function (non-HD group). The clinical data of the patients was reviewed and the clinical characteristics were compared between two groups. Results There was no significant difference in gender, age and other general data between the two groups(all P>0.05). There were significant differences in leukocyte, hemoglobin, C-reactive protein(CRP) and serum albumin levels between the two groups(all P<0.05). The positive rate of staphylococcus culture in the HD group was higher than that in the non-HD group(66.7% vs. 11.6%, P<0.05). The incidence of heart failure (66.7% vs. 23.3%, P<0.05) and the in-hospital mortality(33.3% vs. 4.7%, P<0.05) in HD group were higher than thoset in non-HD group. Conclusion The IE in HD patients is mainly caused by staphylococcal infection and its clinical symptoms are not typical. The involved heart valves are mainly mitral valve and aortic valve, which are prone to heart failure and have a high mortality.

关 键 词：感染性心内膜炎 终末期肾病 血液透析 并发症 

分 类 号：R692.5[医药卫生—泌尿科学] R542.41[医药卫生—外科学]