抗中性粒细胞胞质抗体阳性的感染性心内膜炎三例及文献复习

Infective endocarditis with positive anti-neutrophil cytoplasmic antibodies： three cases report with literature review

目的分析抗中性粒细胞胞质抗体（ANCA）阳性的感染性心内膜炎（IE）的临床表现，与ANCA相关小血管炎（AASV）加以鉴别。方法报告3例ANCA阳性的IE患者的临床特点，结合文献报道的另外13例患者综合分析。结果16例患者除2例PR3-ANCA、MPO—ANCA均阳性外，其余均仅表现为PR3-ANCA阳性。主要临床表现依次为发热（13／16，占81％）；皮疹（8／16，占50％）；急进性肾小球肾炎（7／16，占44％）；脾肿大（6／16，占38％）。病原微生物以链球菌为主（12／14，占86％），16例超声心动图均示瓣膜异常，主动脉瓣和（或）二尖瓣受累达81％。死亡2例（2／16，占13％），分别死于脑出血、脑梗死，其余经敏感抗生素治疗均临床治愈。结论感染性心内膜炎可呈现AASV的某些表现，临床在解读ANCA检测结果时应对二者仔细鉴别。

Objective To analyze the clinical features of infective endocarditis with positive antineutrophil cytoplasmic antibodies ,and compare with ANCA associated small vessel vaseulitis（AASV）. Methods Three IE patients with positive ANCA were analyzed, and 13 cases from literatures were reviewed. Results Sixteen patients had positive anti-PR3 ANCA, in which 2 cases had both positive （anti-PR3 and anti-MPO ANCA） ANCA. All patients had some clinical manifestations mimic AASV, including fever （13/16, 81% ）, rash （8/16, 50%）, rapidly progressive glomerulonephritis （7/16, 44% ）, splenomegaly （6/16, 38% ）. Streptococcal species were identified in 12 patients, and cardiac valvular abnormalities were demonstrated in all patients. All patients except 2, who died of cerebral hemorrhage followed by cerebral infarction, recovered with antibiotic therapy. Conclusion Infective endocarditis sometimes can have the same clinical features as AASV, so physicians should carefully differentiate between them when dealing with patients with positive ANCA antibodies.