感染性心内膜炎患者超声心动图诊断价值分析

The Clinical Diagnosis Value of Echocardiography in Patients with Infective Endocarditis

目的:探讨分析超声心动图对感染性心内膜炎患者临床诊断价值。方法:回顾性分析2009年1月至2015年1月我院收治的疑似为感染性心内膜炎患者64例,比较经胸超声心动图(TTE)以及经食管超声心动图(TEE)对感染性心内膜相关并发症以及赘生物的检出情况,比较TTE与TEE诊断患者心内膜受累各种病理变化的特异性以及敏感性。结果:TTE检出赘生物31例(48.44%)、TEE检出赘生物49例(76.56%),两种检测方式对赘生物的检出率具有统计学差异(P<0.05);TTE检出平均赘生物的大小显著低于TEE检出赘生物的大小(P<0.05);在瓣周脓肿、瓣周漏、瓣膜穿孔、腱索断裂等感染性心内膜炎相关并发症检出方面,两种检测方式检出率无统计学意义(P>0.05);若以TEE检测作为感染性心内膜炎诊断标准,则TTE检出敏感性为63.27%、TTE检出特异性为86.67%。结论:超声心动图对于感染性心内膜炎患者的诊断具有着重要的临床意义,其中TEE对感染性心内膜炎的检出更为敏感,但是TTE对也能够提供较为肯定的证据,目前仍是感染性心内膜炎患者诊断的首选手段。

Objective： To investigate the clinical diagnosis value of echocardiogram in patients with infective endocarditis. Method： The data of 64 patients with suspected infective endocarditis treated in our hospital between January 2009 and January 2015 were retrospectively analyzed, the detection of infective endocarditis - associated complications and excrescences was compared by transthoracic echocardiography （TTE） and by transesophageal echocardiography （ TEE ） , and the sensitivities and specificities of TTE and TEE in diagnosis of various pathological changes in patients with endocardium involved were compared. Result： Excrescences were detected by TTE in 31 patients （48.44%） and by TEE in 49 patients （76.56%） , and the difference in detection rate between the two detection methods was statistically significant （ P〈0.05 ） ; the average size of excrescences detected by rITE was significantly smaller than that detected by TEE （ P〈0. 05） ; the differences in detection rates of endocarditis - associated complications including perivalvular abscess, perivalvular leakage, perforation of cardiac valve and ruptured chordae tendineae by the two detection methods were statistically insignificant （P〉0.05） ; when taking TEE as the diagnostic criterion of infective endocarditis, the sensitivity and specificity of TTE detection were 63.27% and 86.67%, respectively. Conclusion： Echocardiography has important clinical significances in diagnosis of infective endocarditis. TEE is more sensitive for the detection of infective endocarditis, but rITE can also provide positive evidence, and rITE is the first choice for diagnosis of infective endocarditis currently.