感染性心内膜炎两种诊断标准的比较研究

Comparing the two diagnostic criteria for infective endocarditis

目的研究感染性心内膜炎临床特点,比较中国感染性心内膜炎诊断试行标准和Duke诊断标准的临床诊断敏感性。方法回顾性分析经术中病检确诊的感染性心内膜炎119例。比较Duke标准和中国试行标准对感染性心内膜炎的诊断敏感性。结果119例患者术前,两次以上血培养65例(54.6%),均为阳性且为相同致病菌26例(30.6%),超声心动图示赘生物117例(98.3%),瓣膜或瓣周破坏穿孔14例(11.8%),116例(97.5%)有基础心脏病或易患因素。各指标符合中国感染性心内膜炎试行标准者113例,诊断敏感性为94.95%;符合Duke标准者70例,临床诊断敏感性为58.82%,两者敏感性差异有显著性(P<0.01)。结论中国试行标准对感染性心内膜炎诊断的敏感性显著高于Duke标准。

【Objective】 To study the clinic medical character of infective endocarditis,and to compare the sensitivity of the Chinese diagnostic criteria and the Duke diagnostic criteria for infective endocarditis （ IE） in medical practice. 【Method】 The sensitivity predictive value of these two sets of diagnostic criteria were determined by retrospective analyzing of 119 cases of infective endocarditis confirmed by pathological diagnosis. 【Result】65 of 119 patients did blood culture for more than twice,the same microorganisms were detected positive twice in blood culture in 26 patients （30.6%）. The vegetation were detected by echocardiography in 117 of 119 patients （98.3%）. 14 （11.8%） cases are valvular and perivalvular destruction. 116 patients （97.5%） had basic heart disease and high risk factors. The sensitivity of the Chinese and Duke diagnostic criteria are 95% and 58.9% respectively,and has statistically difference （P〈0.01）.【Conclusion】 The Chinese diagnostic criteria is significantly more sensitivity than the Duke criteria for the diagnostic of patients with infective endocarditis followed in medical practice.