感染性心内膜炎的血培养阳性与阴性临床意义  

Clinic Comparison of Culture-positive versus Culture-negative in Infective Endocarditis.

作　　者：曾春来[1] 傅丽霞[1] 陈素芬[1] 韦铁民[1] 

机构地区：[1]浙江丽水市中心医院,323000

出　　处：《心脑血管病防治》2003年第3期11-13,共3页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的　明确血培养阳性与阴性的感染性心内膜炎 (IE)之间在临床特征和预后方面的异同。方法　对63例IE患者 ,根据血培养结果分成阳性组 (N =15 )和阴性组 (N =48) ,比较临床特征和预后。结果　 41例 ( 65 .1% )经超声心动图检出有赘生物 ,两组病人的赘生物检出率、基础心脏病和感染部位一致 ,从入院到确诊时间无显著差异。两组病人入院前有使用抗生素的比率分别为 3 3 .3 %和 85 .4% (P <0 .0 1)。血培养阳性组白细胞计数较阴性组高 (P <0 .0 1) ,因而更易出现发热和脓肿并发症 (P <0 .0 5 ) ,而血培养阴性组更多出现心瓣膜破裂或穿孔 ,严重心衰 ,更多病人施行了心脏换瓣手术 (P <0 .0 5 ) ,但两组病人预后无统计学差异。结论　由于血培养前抗生素的广泛使用 ,IE血培养阳性率明显下降 ,超声心动图检查有助于血培养阴性IE的早期诊断。血培养阴性IE后果更为严重 。Objective To compare clinical feature and prognosis of culture-positive and culture-negative infective endocarditis(IE).Methods According to the result of blood culture,63 IE patients were divided into positive group(n=15)and negative group(n=48),and their clinical feature and prognosis were compared.Results Vegetation was detected in 41 patients (65.1%)by echocardiography.The presence of predisposing factors for IE was similarly distributed in two groups.with respect to the valves affected,the vegetations detected and the time from admission to definite diagnosis,there was no significant difference between two groups.previous administration of antibiotics was significantly higher in culture-negative group(85.4%)than in culture-positive group(33.3%, P <0.01).patients with positive blood culture had higher white blood cell count( P <0.01),more frequent of fever and complication of abscess( P <0.05),while patients with negative blood culture had a more frequent of valve rupture or perforation,heart failure and required more cardiac operation ( P <0.05).There was no significantly difference in prognosis between two groups.Conclusions The proportion of positive blood culture in IE was notably decreased due to previous administration of antibiotics.The routine use of ecocardiography in patients with suspected IE allows an early diagnosis of culture-negative IE.Culture-negative IE had a worse prognosis.Early diagnosis and early surgical treatment can improve the prognosis for these patients.

关 键 词：感染性心内膜炎 血培养 临床意义 预后 早期诊断 治疗 临床意义 

分 类 号：R542.41[医药卫生—心血管疾病]