主动脉瓣感染性心内膜炎瓣膜置换术后远期效果  

Long-term effect of aortic valve infective endocarditis after surgical aortic valve replacement

作　　者：贾一琼 朱光发[1] JIA Yi-qiong;ZHU Guang-fa(Department of Infectious Diseases,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院感染科,北京100029

出　　处：《中国感染控制杂志》2021年第11期1022-1027,共6页Chinese Journal of Infection Control

摘　　要：目的探讨自体主动脉瓣单独受累感染性心内膜炎(IE)对外科主动脉瓣置换术(SAVR)远期预后的影响。方法回顾性分析2013年1月-2017年12月在首都医科大学附属北京安贞医院行SAVR的自体主动脉瓣单独受累IE患者的病历资料,同时采用倾向性评分匹配(PSM)非IE对照组患者,对所有入组患者进行长期随访,观察术后生存率及并发症累积发生风险,中位随访时间为69个月。结果共纳入2821例患者,其中IE SAVR患者143例(IE组),非IE的SAVR患者2678例(对照组)。IE组患者长期生存率低于非IE配对对照组,差异有统计学意义(P=0.044)。IE患者SAVR手术后更容易发生缺血性脑卒中事件,差异有统计学意义(P=0.035),且缺血性脑卒中事件为影响患者生存的独立危险因素(P=0.014),发生缺血性脑卒中患者的死亡风险更高(HR=2.811;95%CI:1.233~6.408)。IE组患者大出血累积发生率和主动脉瓣再手术率与非IE配对对照组比较,差异均无统计学意义(均P>0.05),且均不是影响患者生存的独立危险因素(均P>0.05)。结论与非IE对照组患者相比,自体主动脉瓣单独受累IE患者行SAVR后发生死亡、缺血性卒中的风险更高。应加强对IE患者行SAVR后的密切随访,重点预防脑卒中等并发症。Objective To investigate the effect of native-valve infective endocarditis(IE)on long-term effect of surgical aortic valve replacement(SAVR).Methods Medical records of patients with native-valve IE who underwent SAVR in Beijing Anzhen Hospital,Capital Medical University from January 2013 to December 2017 were analyzed retrospectively,propensity score matching(PSM)was adopted to select patients as control group(non-IE),all patients were followed up for a long period to observe the post-operative survival rate and cumulative risk of complications,the median follow-up time was 69 months.Results A total of 2821 patients were included in study,including 143 SAVR patients with IE(IE group)and 2678 SAVR patients without IE(control group).The long-term survival rate of patients in IE group was lower than that of control group,difference was significant(P=0.044).Patients with IE were more likely to have ischemic stroke after SAVR,difference was significant(P=0.035),ischemic stroke was an independent risk factor affecting the survival of patients(P=0.014),patients with ischemic stroke had a higher risk of death(HR=2.811;95%CI:1.233-6.408).There was no significant diffe-rence in the cumulative incidence of massive hemorrhage and aortic valve re-operation rate between patients in IE group and control group(both P>0.05),and they were not independent risk factors affecting the survival of patients(all P>0.05).Conclusion Compared with patients in control group,patients with native-valve IE have a higher risk of death and ischemic stroke after SAVR.The close follow-up of IE patients after SAVR should be strengthened,focusing on the prevention of complications of stroke.

关 键 词：感染性心内膜炎 外科主动脉瓣置换术 队列研究 随访 

分 类 号：R542.41[医药卫生—心血管疾病]