左心无基础瓣膜病感染性心内膜炎患者的临床特征分析  

Clinical characteristics of left-sided infective endocarditis without underlying valvular heart diseases

作　　者：吴娜 汤正好[1] 陈小华[1] 余永胜[1] 张毅[1] Wu Na;Tang Zhenghao;Chen Xiaohua;Yu Yongsheng;Zhang Yi(Department of Infectious Diseases,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院感染病科,上海200233

出　　处：《中华全科医师杂志》2025年第1期82-88,共7页Chinese Journal of General Practitioners

基　　金：中华医学会医学教育分会和中国高等教育学会医学教育专业委员会医学教育研究课题(2016B-JJ030)。

摘　　要：目的分析左心无基础瓣膜病感染性心内膜炎(IE)患者的临床特征。方法该研究为回顾性研究。纳入2011年6月至2021年5月上海交通大学医学院附属第六人民医院出院诊断为左心IE的患者。根据左心是否有基础瓣膜病分为左心有基础瓣膜病组(瓣膜病+IE组)和左心无基础瓣膜病组(IE组)。收集入选患者的临床资料。采用Kaplan-Meier生存曲线分析左心有/无基础瓣膜病IE患者出院后6个月生存率, 并进一步在左心无基础瓣膜病IE患者中分析不同赘生物大小、治疗方式的患者出院后6个月生存率, 采用log-rank法进行组间差异比较。结果入选患者206例, 年龄(50.4±16.1)岁, 男性144例(69.9%), 其中瓣膜病+IE组129例, IE组77例。IE组年龄≥65岁、心律失常、主动脉瓣受累患者的比例低于瓣膜病+IE组(均P<0.05), 住院死亡率亦低于瓣膜病+IE组(P<0.05)。IE组发热+言语含糊/肢体活动障碍/头痛、二尖瓣受累患者的比例高于瓣膜病+IE组(均P<0.05), C反应蛋白水平高于瓣膜病+IE组(P<0.05), N末端B型利钠肽原水平低于瓣膜病+IE组(P<0.05)。两组患者细菌/真菌血培养阳性以及赘生物同时累及二尖瓣和主动脉瓣患者比例差异无统计学意义(均P>0.05)。Kaplan-Meier生存曲线分析结果显示, IE组患者出院后6个月生存率有低于瓣膜病+IE组的趋势, 但差异无统计学意义(88.7%比93.6%, P=0.346);在左心无基础瓣膜病IE患者中, 赘生物最大径≤10 mm的患者出院后6个月生存率高于赘生物最大径>10 mm的患者(96.3%比80.7%, P=0.043), 抗菌药物联合手术治疗患者出院后6个月生存率有高于单纯抗菌药物治疗的趋势, 但差异无统计学意义(96.2%比78.6%, P=0.084)。结论左心无基础瓣膜病IE多累及二尖瓣, 相较于左心有基础瓣膜病的患者较为年轻者占比高, 住院死亡率较低。在左心无基础瓣膜病IE患者中, 赘生物最大径≤10 mm的患者生存率较高, 而抗菌药物Objective To investigate the clinical characteristics of left-sided infective endocarditis(IE)without underlying valvular heart diseases(VHD).MethodsThis was a retrospective study.Clinical data of 206 patients with left-sided IE(age:(50.4±16.1)years;144 males(69.9%))discharged from Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2011 to May 2021 were retrospectively analyzed,including 129 cases with underlying VHD(IE+VHD group)and 77 cases without underlying VHD(IE group).The 6-month survival rate of patients after discharge was analyzed with Kaplan-Meier survival curve;and the 6-month survival rates of the patients with different sizes of endocardial vegetation and different treatment modalities in the IE group were further analyzed with log-rank method.ResultsThe proportions of patients with age≥65 years old,arrhythmia and aortic valve involvement,and the in-hospital mortality in the IE group were significantly lower than those in the IE+VHD group(P<0.05).However,the proportion of patients with fever and speech vague/limb movement disorder/headache,those with mitral valve involvement in the IE group were significantly higher than those in the IE+VHD group(P<0.05).The median value of C-reactive protein(CRP)in the IE group was significantly higher than that in the IE+VHD group(P<0.05).Nevertheless,the median value of N-terminal pro-B-type natriuretic peptide(NT-proBNP)in the IE group was significantly lower than that in the IE+VHD group(P<0.05).There were as no significant differences in the positive rates of bacterial/fungal blood cultures and the proportion of patients with mitral and aortic valve involvement of endocardial vegetation between the two groups(all P>0.05).Kaplan-Meier survival curve analysis showed that there was no significant difference in 6-month survival rate of patients between the IE group and IE+VHD group(88.7%vs.93.6%,log-rankχ^(2)=0.887,P=0.346).In the IE group,the 6-month survival rate after discharge in patients with maximu

关 键 词：感染性心内膜炎 心脏瓣膜疾病 临床特征 

分 类 号：R542.41[医药卫生—心血管疾病]