小儿感染性心内膜炎死亡危险因素及病原学特点分析

Infective endocarditis in children： analysis of risk factors and pathogenic feature

目的分析小儿感染性心内膜炎死亡的危险因素及病原学特点。方法运用回顾性病例对照研究策略对2000年1月至2007年6月间上海儿童医学中心收治的46例感染性心内膜炎患儿的临床资料进行总结，研究因素包括性别、原发病、感染部位、培养结果、并发症、治疗措施等16个变量，建立Logistic回归模型。结果感染性心内膜炎患儿（46例）占同期住院患儿总数的0．78‰，其中40例有心脏疾患，左侧心内膜炎的发病率比右侧高。24例血培养阳性，1例赘生物菌培养阳性。总的细菌培养阳性率为54％。在25例阳性结果中，革兰阳性菌15例，其中常见病原菌为α-溶血性链球菌；革兰阴性菌7例；真菌3例。46例患儿治愈40例，死亡6例。Logistic回归模型示与死亡有关的因素包括血培养阴性（OR=25．127，95％CI为1．110～363．236）、血液疾病（OR=28．620，95％CI为2．261～354．448）和多器官功能衰竭（OR=19．843，95％CI为0．786～221．754）。结论小儿感染性心内膜炎的病原菌以α-溶血性链球菌最常见，左侧心内膜炎的发病率比右侧高。血培养阴性、血液疾病和多器官功能衰竭是预后不良的危险因素。

Objective To investigate pediatric infective endocarditis（IE） risk factors and the fehture of pathogen. Methods We conducted a retrospective study of 46 cases who were diagnosed as IE from January 2000 to June 2007. Sixteen variables such as sex, primary disease, infectious site, complication, culture result and therapeutic measure were selected for logistic regression analysis. Results Forty-six IE patients accounted for 0.78%o of all the hospitalized patients during the same period. Of 46 cases, 40 had heart diseases. The incidence rate of left-sided endocarditis was higher than that of right-sided endocarditis. Twenty-four had positive blood culture result, one patient had positive culture from vegetation sample. The total positive culture rate was 54 %. Gram-positive bacteria were found in 15 cases, and the most common organisms were a-hemolytic strep- tococcus. Gram-negative bacteria were in 7 cases and fungus infection was present in 3 cases. After antiboitic treatment, 40 were cured, 6 died. In the logistic regression model, the variables significantly associated with death included negative blood culture （ OR = 25.127, 95 % CI = 1.110-363. 236）, hematological system disease （ OR = 28.620, 95 % CI = 2. 261-354. 448） and multiple organ failure （ OR = 19. 843, 95 % CI = 0. 786- 221.754） .Conclusion Streptococcus viridans is the most common pathogen in pediatric IE in our hospital. Higher incidence in the left heart than that in the right heart is found. Negative blood culture, hematological system disease and MOF are the risk factors in IE patients.