人工心脏瓣膜心内膜炎的诊断与治疗进展

Progress in Diagnosis and Therapeutic Strategies for Prosthetic Valve Endocarditis

虽然人工瓣膜心内膜炎（PVE）少见，却是心脏瓣膜置换术后严重的、灾难性并发症，其发病率逐年升高。金黄色葡萄球菌为当今PVE主要致病菌。目前PVE诊断仍困难，治疗策略难以抉择。在某些患者，长期抗生素治疗有效，需静脉应用最大耐受剂量抗生素至少4～6周，继之口服。新批准的抗生素如达托霉素、利奈唑胺、喹奴普丁-达福普汀抗菌谱广，作用迅速，对有生物被膜的微生物也有抗菌活性。有并发症的PVE常需手术干预，住院病死率高。内科及外科治疗虽然可使PVE预后改善，但PVE结局仍恶劣。人们期待前瞻性研究为依据的指南或共识问世以指导PVE的理想治疗。

Prosthetic valve endocarditis （PVE）, although uncommon, is one of the serious and catastrophic complications occurred after heart valve surgery. Incidence of PVE is progressively increased in recent years. Staphylococcus aureus is the leading cause of PVE. The diagnosis and therapeutic strategies of PVE are still the most difficult problem that physicians have to deal with. Long-term antimicrobial regimen, initially given intravenously at the maximal tolerated dose for at least 4-6 weeks, and followed by a sequential oral regimen, may be effective in some patients with PVE. The newly available antibacterial agents, such as daptomycin, linezolid and quinupristin/dalfopristin, all have a wide range of antimicrobial spectrum, show fast microbicidal activity, including the activity against biofilmforming microorganisms. The mortality of hospitalized patients with PVE-associated complications remains high, despite the frequent use of surgical intervention. Even though the medical and surgical therapy can, to a certain extent, improve the prognosis of these patients, PVE is still a severe disease. The guidelines based on prospective studies or consensus on the optimal therapeutic approach of PVE are highly expected.