802例感染性心内膜炎主要基础病因及病原学分析  

Pathogen Distribution and Clinical Characteristics Analysis of 802 Patients With Infective Endocarditis

作　　者：程军[1] 胡欢 张海华[2] 高国峰[2] 王浩[2] 王飞燕[1] 周洲[1] CHENG Jun;HU Huan;ZHANG Haihua;GAO Guofeng;WANG Hao;WANG Feiyan;ZHOU Zhou(Laboratory Diagnostic Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院实验诊断中心,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院心内科,北京市100037

出　　处：《中国循环杂志》2020年第2期180-184,共5页Chinese Circulation Journal

基　　金：医科院创新工程项目(2016-12M-1-016)

摘　　要：目的:探讨感染性心内膜炎(IE)患者的主要基础病因及病原菌分布的特点。方法:针对中国医学科学院阜外医院2011年1月至2018年12月住院治疗的802例IE患者的基础病因和致病病原体进行回顾性分析,并分析IE患者的平均年龄、血培养和赘生物培养的阳性率及其变化趋势。结果:近8年IE患者平均年龄由2011年的40.3岁增至2018年的46.8岁,总平均年龄为42.8岁,男女患者比为3.18:1。其中,非风湿性心脏瓣膜病基础上发生的IE共410例(51.12%);在先天性心脏病基础上发生的IE共208例(25.94%);风湿性心脏瓣膜病基础上发生的IE共101例(12.59%);在心脏外科手术及介入治疗术后发生的IE共70例(8.73%)。802例IE患者共送检了535例血培养,阳性156例(29.16%);共送检576份瓣膜赘生物培养,102例(17.71%)培养阳性。156例IE患者血培养的主要分离菌为链球菌,共98例(62.82%);其次为葡萄球菌38例(24.36%)和肠球菌10例(6.41%)。IE患者瓣膜赘生物培养的主要分离菌为链球菌和葡萄球菌,分别有34例(33.33%)和33例(32.35%)。血培养中链球菌对青霉素的耐药率为3.10%,对万古霉素的耐药率为0%。结论:近8年IE患者的平均年龄增高。IE的基础心脏疾病中,风湿性心脏病减少,先天性心脏病相对增加,非风湿性心脏瓣膜病已成为IE最常见的基础心脏疾病。其主要病原菌仍以草绿色链球菌为主。Objectives:This retrospective study is performed to investigate the basic clinical etiology and pathogen distribution of patients with infective endocarditis(IE).Methods:The basic clinical etiology and pathogens of 802 IE patients hospitalized in Fuwai Hospital from January 2011 to December 2018 were analyzed retrospectively.The average age of IE patients,the positive rates of blood culture and vegetation culture were analyzed.Results:Data form IE patients hospitalized in our hospital in the recent 8 years showed that the average age of IE patients was 42.8 years,and the ratio of male to female patients was 3.18:1.Non-rheumatic valvular disease accounted for 51.12%(410/802),congenital heart disease for 25.94%(208/802),rheumatic heart disease for 12.59%(101/802),post cardiac surgery and interventional therapy for 8.73%(70/802),hypertrophic cardiomyopathy for 1.25%(10/802)and unknown etiology for 0.37%(3/802).The positive rates of blood culture and vegetation culture were 29.16%and 17.71%,respectively.Of the blood culture,Streptococcus accounted for 62.82%,followed by Staphylococcus and Enterococcus,accounting for 24.36%and 6.41%,respectively.Of the valve culture,Streptococcus and Staphylococcus were the main isolates accounting for 33.33%and 32.35%respectively.The resistance rate of Streptococcus to penicillin and Vancomycin in blood culture was 3.10%and 0%,respectively.Conclusions:The average age of IE patients increased in recent eight years.Among IE's basic etiology,proportion of rheumatic heart disease decreased and congenital heart disease increased.Non-rheumatic heart valvular disease has become the most common basic cardiac disease in IE.The main pathogen of IE is Streptococcus viridans.

关 键 词：感染性心内膜炎 流行病学 病原菌 耐药性 

分 类 号：R541[医药卫生—心血管疾病]