超声在感染性心内膜炎换瓣术前的诊断价值

Value of ultrasound in diagnosis of infectious endocarditis before valve replacement surgery

目的探讨经胸超声心动图(TTE)及经食道超声心动图(TEE)在感染性心内膜炎换瓣术前的诊断价值,为感染性心内膜炎换瓣术前的诊断提供参考。方法共纳入85例来医院的可疑严重感染性心内膜炎需行换瓣术治疗的患者,入院时均详细记录患者的相关病史,并行TTE及TEE检查,以最终赘生物直接的组织病理学和微生物分析确诊为金标准,评价两者对感染性心内膜炎的诊断价值。结果 TTE对感染性心内膜炎的诊断价值结果显示,敏感度为68.0%,特异度为68.6%,阳性似然比为0.76,阴性似然比0.60;TEE对感染性心内膜炎的诊断价值结果显示:敏感度为90.0%,特异度为85.7%,阳性似然比为0.90,阴性似然比0.86。结论感染性心内膜炎换瓣术前行TEE有重要的临床诊断价值,与TTE相比,TEE的诊断敏感度及特异度更高,可以更好地应用于临床。

OBJECTIVE To explore the value of transthoracic echocardiography （TTE） and transesophageal echocardiography （TEE） in diagnosis of the infectious endocarditis before the valve replacement surgery so as to guide the diagnosis of the infectious endocarditis before the valve replacement surgery. METHODS The participants included 85 patients suspected to be the serious infective endocarditis who needed to receive the valve replacement surgery, the related disease history of the patients was recorded in detail on the admission, the TTE and TEE inspection were performed so as to set eventual vegetations direct histopathology and microbiological analysis as the gold standard. The value in diagnosis of the infectious endocarditis was evaluated. RESULTS The result of diagnostic value of infectious endocarditis with TTE showed that the sensitivity was 68. 0%, the specificity was 68.6 %, the positive likelihood ratio was 0.76, and the negative likelihood ratio was 0. 60, while the result of diagnostic value of infectious endocarditis with TEE indicated that the sensitivity was 90.0 %, the specificity 85.7%, the positive likelihood ratio 0.90, and the negative likelihood ratio 0.86. CONCLUSION TEE has great value in diagnosis of the infectious endocarditis before the valve replacement surgery, as compared with TTE,it has higher sensitivity and specificity and is more suitable for the clinical application.