感染性心内膜炎致病菌分布与临床特征  

Pathogen distribution and clinical characteristics of 80 patients with infective endocarditis

作　　者：李佳[1] 王树敏 胡淑华 谭金哲[2] 钟册俊[1] LI Jia;WANG Shumin;HU Shuhua;TAN Jinzhe;ZHONG Cejun(Center for Infectious Diseases,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Experimental Medicine,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院感染性疾病中心,四川成都610041 [2]四川大学华西医院实验医学科,四川成都610041

出　　处：《西部医学》2020年第10期1488-1491,共4页Medical Journal of West China

基　　金：四川省科技厅社发重点研发项目(2017SZ0140)。

摘　　要：目的分析感染性心内膜炎患者致病菌分布情况与临床特征。方法选择2016年10月~2019年9月我院收治的80例感染性心内膜炎患者作为研究对象,收集其临床资料,观察患者致病菌分布情况及临床特征。结果80例患者血样共检出病原菌株36株,检出病原菌株中革兰阳性菌占比88.89%,真菌占比11.11%。革兰阳性菌中占比最高的为酿脓链球菌(38.89%),其次为金黄色葡萄球菌(19.44%)、D链球菌(11.11%)和表皮葡萄球菌(11.11%)。感染性心内膜炎患者中最常见临床表现为发热(92.50%),其次为心脏杂音(88.75%)、疲乏(83.75%)、盗汗(81.25%)。97.50%的患者超声心动图检查可见心脏赘生物。80例患者中有6例死亡,死亡率为7.50%。死亡组先天性心脏病、人工瓣膜、Hb<90g/L、ALB<30g/L和栓塞所占比例均高于存活组(P<0.05),外科手术治疗占比低于存活组(P<0.05)。多因素Logistic回归分析显示,先天性心脏病、人工瓣膜、Hb<90g/L、脑栓塞是感染性心内膜炎患者预后的危险因素(P<0.05),手术治疗是其保护因素(P<0.05)。结论感染性心内膜炎患者血样病原菌中革兰阳性菌占比最高,绝大多数患者超声心动图可见心脏赘生物,部分伴有基础心脏疾病,及早诊断并合理使用抗菌药物,警惕预后危险因素,及时给予外科手术治疗,对改善患者预后具有重要价值。Objective To observe and analyze the pathogen distribution and clinical characteristics of patients with infective endocarditis and provide a basis for clinical diagnosis and treatment of such patients.Methods 80 patients with infective endocarditis admitted to the hospital between October 2016 and September 2019 were selected as the study subjects.Their clinical data were collected to observe the pathogen distribution and clinical characteristics of patients.Results A total of 36 strains of pathogens were detected in the blood samples of the 80 patients,including Gram-positive bacteria(88.89%)and fungi(11.11%).In Gram-positive bacteria,the proportion of Streptococcus pyogenes was the highest(38.89%),followed by Staphylococcus aureus(19.44%),group D Streptococcus(11.11%)and Staphylococcus epidermidis(11.11%).Fever(92.50%)was the most common clinical manifestation of patients with infective endocarditis,followed by cardiac murmur(88.75%),fatigue(83.75%)and night sweat(81.5%).Cardiac neoplasms were found by echocardiography in 97.50%of the patients.6 of the 80 patients died,with a mortality rate of 7.50%.The proportions of congenital heart disease,prosthetic valve,Hb<90 g/L,ALB<30 g/L and embolism in the death group were higher than those in the survival group(P<0.05),and the proportion of surgical treatment was lower than the survival group(P<0.05).Multivariate Logistic regression analysis showed that congenital heart disease,artificial valve,Hb<90 g/L and cerebral embolism were the prognostic risk factors in patients with infective endocarditis(P<0.05),and surgical treatment was a protective factor(P<0.05).Conclusion The proportion of Gram-positive bacteria is the highest in pathogens from blood samples of patients with infective endocarditis.Cardiac neoplasms are found in most patients by echocardiography,and some of the patients are complicated with basic heart disease.Early diagnosis,reasonable use of antibacterial drugs,keeping alert of prognostic risk factors and timely surgical treatment are of great value

关 键 词：感染性心内膜炎 致病菌 临床特征 抗菌药物 心脏疾病 

分 类 号：R524.41[医药卫生—内科学]