二尖瓣脱垂与感染性心内膜炎38例患者的临床分析

Mitral valve prolapse and infectous endocarditis:A clinical analysis of 38 cases.

目的分析二尖瓣脱垂患者中感染性心内膜炎的临床和超声心动图特点。方法本院1988年1月至2006年12月住院原发性二尖瓣脱垂(MVP)并发感染性心内膜炎(IE)患者共38例,回顾分析其临床资料。结果MVP并发IE占同期IE发病总数的15.0%,均有发热、心尖部3～4级收缩期杂音。20例(52.6%)有Osler结或肢端皮下出血,15例(39.5%)有大动脉栓塞表现。50%有白细胞增高,平均12.06×109/L;95.7%的病例红细胞沉降率加快,平均48.2 mm/h。11例(28.9%)有不同程度贫血。血培养阳性者20例(52.6%),多为链球菌(80.0%)。二尖瓣前叶脱垂者占78.9%,后叶脱垂者占39.5%,前后叶均脱垂者占18.4%,发现二尖瓣前叶有赘生物者占71.1%,后叶有赘生物者占26.3%;无赘生物者5例,占13.2%,前后叶均有赘生物者5例,占13.2%。1例因脑疝导致死亡。结论MVP是IE的常见病因,其临床特点为起病隐匿,体循环栓塞等并发症的发生率较高。超声心动图检查对于诊断具有重要价值,经食管超声心动图检查对于发现瓣膜赘生物有较高敏感性。

Objective To investigate the clinical and echocardiographic characteristics of infectious endocarditis （IE） in patients with mitral valve prolapse （MVP）. Methods Data of 38 patients with IE and MVP were analysed retrospectively. Results 15, 0% of IE cases were MVP patients. All of the patients had fever and systolic murmur at apex. 28.9% of the patients had mild or moderate anaemia and 95, 7% had an elevated ESR, with an average value of 48.2mm/hr. Leucocytosis was present in about half of the patients. Osler nodules or acromelic subcutaneous haemorrhages were seen in 20 （52.6%） cases, embolism in 15 （39.5%） cases. Positive culture was obtained in 20 （52, 6% ） patients, streptococci were the commonest offending organisms （80%）. Posterior leaflet prolapse was found in 39.5% of the patients, anterior leaflet prolapse in 78.9% of the patients, and both leaflets prolapse in 18.4% of the patients. Vegetations were found in 26.3% of posterior leaflets, 71.1% of anterior leaflets and 13.2% of both leaflets. One patient died of brain hernia. Condusion MVP is a common cause of IE. Clicinal features were insidious onset, high incidence of serious complications such as emboli in large vessels. Echocardiography played an important role in the diagnosis of the disease. For the detection of valve vegitation, transoesephageal echocardiography is more sensitive than transthoracic echocardiography.