单纯抗菌药物治疗和联合手术治疗对感染性心内膜炎患者预后的影响  

Effects of antibiotic treatment and antibiotics combined with surgery treatment on the prognosis of patients with infective endocarditis

作　　者：吴娜 顾艳婷 陈小华[1] 奚敏[1] 江红[1] 汤正好[1] 臧国庆[1] 余永胜[1] 张毅[1] Wu Na;Gu Yanting;Chen Xiaohua;Xi Min;Jiang Hong;Tang Zhenghao;Zang Guoqing;Yu Yongsheng;Zhang Yi(Department of Infectious Diseases,Shanghai Jiao Tong University Affiliated Sixth People′s Hospital,Shanghai 200233,China;Department of Ultrasound,Shanghai Jiao Tong University Affiliated Sixth People′s Hospital,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院感染病科,上海200233 [2]上海交通大学附属第六人民医院超声科,上海200233

出　　处：《中华传染病杂志》2022年第10期591-596,共6页Chinese Journal of Infectious Diseases

摘　　要：目的探讨单纯抗菌药物治疗和抗菌药物联合手术治疗对感染性心内膜炎(infective endocarditis, IE)患者预后的影响。方法纳入2011年6月至2021年5月于上海交通大学附属第六人民医院就诊的240例IE患者, 收集其临床资料及预后情况。按治疗方式分成单纯抗菌药物治疗组和抗菌药物联合手术治疗组, 比较两组的临床特征及预后, 探讨IE患者的手术时机, 分析两种治疗方式对IE患者预后的影响。统计学分析采用Wilcoxon秩和检验、χ2检验、Kaplan-Meier生存分析和Cox回归分析。结果 240例IE患者中, 单纯抗菌药物治疗组63例, 抗菌药物联合手术治疗组177例。倾向性评分匹配后, 抗菌药物联合手术治疗组1年内病死率为11.1%(4/36), 低于单纯抗菌药物治疗组的33.3%(12/36), 差异有统计学意义(χ2=5.14, P=0.023)。IE患者手术后左室射血分数、左室舒张末期直径、左室短轴缩短率的中位数分别为59%、47 mm、31%, 低于手术前的63%、54 mm、34%, 差异均有统计学意义(Z=6.19、9.36、6.11, 均P<0.001)。最常见的手术指征是中重度心力衰竭。早期手术组与晚期手术组的手术指征差异均无统计学意义(均P>0.050)。抗菌药物联合手术治疗组1年累积生存率为94.9%, 高于单纯抗菌药物治疗组的83.2%, 差异有统计学意义(χ2=7.38, P=0.007)。心力衰竭、Pitt菌血症评分≥4分是IE患者1年全因死亡的独立危险因素[风险比(hazard ratio,HR)=5.668、19.392, 均P<0.050], 住院天数、抗菌药物联合手术治疗是降低IE患者1年全因死亡风险的独立相关因素(HR=0.931、0.299, 均P<0.050), 其中Pitt菌血症评分≥4分对IE患者1年预后的影响最大。结论手术治疗可显著改善IE患者的心功能及1年预后。对于心力衰竭、Pitt菌血症评分≥4分的IE患者, 应积极治疗。Objective To investigate the effects of antibiotic treatment and antibiotics combined with surgery treatment on the prognosis of patients with infective endocarditis(IE).Methods The clinical data and prognosis of all patients diagnosed as IE discharged from Shanghai Jiao Tong University Affiliated Sixth People′s Hospital from June 2011 to May 2021 were collected.There were 240 IE patients,divided into antibiotic treatment group and the antibiotics combined with surgery group according to the treatment methods.The clinical characteristics and prognosis of the IE patients were compared between the two groups,so as to investigate the timing of surgery for IE patients and to analyze the effects of the two treatment methods on the prognosis of IE patients.Statistical analysis methods including Wilcoxon rank sum test,chi-square test,Kaplan-Meier survival analysis and Cox regression analysis were used when appropriate.Results Of the 240 patients with IE,63 cases were only treated with antibiotics and 177 cases were treated with antibiotics combined with surgery.After propensity score matching(PSM),one-year mortality rate of the IE patients in the antibiotics combined with surgery group was 11.1%(4/36),which was significantly lower than that in the antibiotic treatment group(33.3%(12/36),χ2=5.14,P=0.023).The median values of left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)and left ventricular fractional shortening(LVFS)in the antibiotics combined with surgery group were 59%,47 mm and 31%,respectively,which were significantly lower than those before surgery(63%,54 mm and 34%,respectively,Z=6.19,9.36 and 6.11,respectively,all P<0.001).The most common surgical indication was moderate to severe heart failure,and there was no significant difference between the early operation group and the late operation group(both P>0.050).The one-year cumulative survival rate of antibiotics combined with surgery group was 94.9%,which was significantly higher than that in the antibiotic treatment gro

关 键 词：感染性心内膜炎 抗菌药物治疗 手术治疗 预后 

分 类 号：R654.2[医药卫生—外科学]