感染性心内膜炎205例诊断析评

Diagnosis of infective endocarditis by Duke criteria and a new national criteria in a cohort of 205 patients

目的评析Duke标准和试行标准对中国人感染性心内膜炎（infective endoearditis，IE）诊断的价值。方法以Duke标准和中国试行标准对2004-2008年我院收治的205例临床诊断为IE及其中经病理证实的97例IE进行诊断评估，并比较两种标准对IE诊断的敏感性和特异性。结果205例IE患者中，连续2次或2次以上血培养阳性并为相同致病菌13例（6．3％），超声心动图检出赘生物183例（89．3％）；97例经病理证实病例中，连续2次或2次以上血培养阳性并为相同致病菌6例（6．2％），89例（91．8％）超声心动图检出赘生物。97例经病理证实病例中按Duke标准44例（45．5％）被确诊为IE。按中国试行标准，86例（88．7％）被确诊为IE，其中42例（43．3％）符合心内膜受累超声心动图征象加2项次要临床指标。97例经病理证实病例对Duke标准和中国试行标准诊断的敏感性分别为45．5％和88．7％（P〈0．05），而特异性分别为100％和95．7％（P〉0．05）。结论中国试行标准增加心内膜受累超声心动图征象和2项次要标准作为临床确诊条件对IE的诊断敏感性明显优于Duke标准，而特异性无明显差异。

Objective To compare the value of the new national criteria （2 major or one major plus 3 minor criteria） with the Duke criteria for diagnosis of infective endocarditis （IE）. Methods A total of 205 patients with clinical diagnosis of IE admitted at West China Hospital of Sichuan University were included in this study. Among them, IE was pathologically confirmed in 97 patients. The sensitivities of both criteria for the diagnosis of IE were compared. Results In 205 cases, the same microorganisms were detected twice in blood cultures in 13 cases （8. 3% ）. Vegetations were detected by echocardiography in 183 patients （89. 3% ）. In 97 cases with pathologically confirmed IE, the same microorganisms were detected twice in blood cultures in 6 cases （6. 2% ）. Vegetations were detected by echocardiography in 89 patients （91.8%）. IE diagnose was made in 44 （45.5%） and 86 （88. 7%, P 〈0.05 vs. Duke criteria） out of 97 pathologically confirmed IE patients by the Duke criteria and new national criteria, respectively. The specificities were 100% and 95.7% by Duke and new national criteria, respectively （P 〉 0. 05 ）. Conclusion With the addition of echocardiographic evidence of endocardial involvement and 2 minor criteria as definite diagnostic criteria, the sensitivity of the new national criteria is superior to that of the Duke criteria for diagnosing IE and the specificity for the diagnosis of IE between the two criteria is similar.