感染性心内膜炎模拟系统性血管炎1例并文献复习  

A case of infective endocarditis simulating systemic vasculitis and literature review

作　　者：毛丽 朱传苗 刘瑞韬 何倩 贾兰兰 强孚勇[1] 陈兰芳[1] 李志[1] Mao Li;Zhu Chuanmiao;Liu Ruitao;He Qian;Jia Lanlan;Qiang Fuyong;Chen Lanfang;Li Zhi(Department of Rheumatology and Immunology,Yijishan Hospital of Wannan Medical College,Wuhu,Anhui 241001,China)

机构地区：[1]皖南医学院弋矶山医院风湿免疫科,安徽芜湖241001

出　　处：《齐齐哈尔医学院学报》2024年第11期1043-1047,共5页Journal of Qiqihar Medical University

基　　金：2021年度芜湖市科技计划项目(2021cg41);皖南医学院弋矶山医院三新项目(Z22010)。

摘　　要：目的提高对感染性心内膜炎并发症的临床认识和鉴别诊断能力。方法回顾分析2022年8月15日本院收治的1例感染性心内膜炎患者的临床、实验室、影像学资料及治疗转归,结合国内外相关文献进行复习。结果感染性心内膜炎可表现出类似于原发性系统性血管炎的临床表现及实验室指标特征,从而增加疾病诊断的挑战性。动态复查心脏彩超有助于感染性心内膜炎早期诊断,糖皮质激素及免疫抑制剂对感染性心内膜炎临床症状改善作用有限,对改善实验室指标有一定作用,抗生素治疗及心脏瓣膜手术是关键性治疗手段。结论以多系统受累为临床表现的疑似系统性血管炎患者,需要警惕感染性心内膜炎的可能,糖皮质激素及免疫抑制剂在感染性心内膜炎模拟系统性血管炎治疗中患者有一定获益,早期诊断、规范治疗是改善感染性心内膜炎预后的关键因素。Objective To improve the clinical understanding and ability of differential diagnosis of complications of infective endocarditis.Methods The clinical,laboratory,imaging data and treatment outcome of a case of infective endocarditis was retrospectively analyzed,and the relevant literature both at home and abroad were reviewed.Results Infective endocarditis might present similarly clinical manifestations and features of laboratory indicators of primary systemic vasculitis,and thus increasing the challenge of disease diagnosis.Repeated echocardiography was helpful for early diagnosis of infective endocarditis.Glucocorticoids and immunosuppressants had limited effect on improving clinical symptoms of infective endocarditis,but had a certain effect on improving laboratory indicators.Antibiotic therapy and heart valve surgery were the key therapeutic means.Conclusions Patients suffering from suspected systemic vasculitis with multiple system involvement need to be wary of infective endocarditis.Glucocorticoids and immunosuppressants have certain benefits to patients with infective endocarditis simulating systemic vasculitis.Early diagnosis and standardized treatment are the key factors to improve the prognosis of infective endocarditis.

关 键 词：感染性心内膜炎 系统性 血管炎 

分 类 号：R593.2[医药卫生—内科学]