青年感染性心内膜炎患者合并卒中临床分析

Clinical study of stroke in young adults with infective endocarditis

目的 探讨青年感染性心内膜炎（IE）患者卒中的发病情况及临床特点.方法 回顾性分析首都医科大学附属北京安贞医院2003年1月至2013年3月收治的临床诊断为IE的青年患者的临床资料.结果 共纳入300例临床确诊IE患者,男209例,女91例,年龄（31.8±7.8）岁,其中14例为人工心脏瓣膜心内膜炎.300例患者全部发现赘生物,262例（87.3％）赘生物分布于二尖瓣和/或主动脉瓣.基础疾病主要为先天性心脏病和风湿性心瓣膜病.35例（1 1.7％）患者并发卒中,其中脑梗死21例（含脑梗死并出血转化7例）,脑出血9例,蛛网膜下腔出血3例,另外2例卒中性质未定.21例并发脑梗死患者中,梗死主要分布于颈内动脉系统供血区,5例分布于多个动脉系统供血区.9例脑出血患者出血部位均位于脑叶,主要为颈内动脉系统分布区.所有卒中患者均有二尖瓣或主动脉瓣赘生物.卒中患者中左侧心内膜炎及风湿性心瓣膜病比例显著高于不伴卒中的患者[100.0％ （35/35）比86.4％（229/265）,P=0.02;22.8％（8/35）比6.4％ （17/265）,p=0.001].logistic回归分析显示,风湿性心瓣膜病对于青年IE患者并发卒中的OR值为4.950（95％ CI 1.626～15.072）.伴发卒中对患者死亡的OR值为8.387 （95％ CI 1.997 ～35.225）.结论 在青年IE患者中卒中较常见,其中脑梗死可多发并涉及多个血管系统,易发生出血转化;脑出血多发生于脑叶.风湿性心瓣膜病可能是青年IE患者并发卒中的危险因素.卒中是青年IE患者死亡的独立危险因素.

Objective To investigate the clinical features of stroke in young adults with infective endocarditis （IE）.Methods This is a retrospective analysis of clinical data of young patients （aged between 18 and 44 years） diagnosed with IE in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2003 to March 2013.Results Three hundred IE patients （209 male and 91 female） were enrolled with mean age of （31.8±7.8） years old.Fourteen of them were prosthetic valve endocarditis.All of the cases were found vegetations.The vegetations were mainly distributed in the mitral valve and/or aortic valve （262/300 patients）.Congenital heart disease and rheumatic valvular disease were most frequently background diseases.Thirty-five cases （11.7%） were complicated with stroke.Among them,21 cases were with cerebral infarction （including 7 subjects with hemorrhagic transformation）,9 cases with cerebral hemorrhage,3 cases with subarachnoid hemorrhage,and 2 with reasons unknown.Within the 21 cerebral infarction cases,the infarction sites were mainly distributed in internal carotid artery system with 5 cases involving bilateral internal carotid artery systems and 2 vertebro-basilar artery systems.As to the cerebral hemorrhage,lobar were the bleeding sites in all cases,and mainly distributed in internal carotid artery system.The proportions of left-sided endocarditis and rheumatic valvular disease were significantly higher in patients with stroke than those without [100.0% （35/35） vs 86.4% （229/265）,P =0.02;22.8% （8/35） vs 6.4% （17/265）,P =0.001,respectively].Regression analysis showed that the OR of the rheumatic valvular disease for stroke in young IE patients was 4.950 （95% CI 1.626-15.072）,and the OR of stroke for death was 8.387 （95% CI 1.997-35.225）,respectively.Conclusions Stroke is common in young patients with IE.Cerebral infarction often involves multiple vascular systems,and is prone to hemorrhagic transformation.Intracerebral hemorrhage often occurs in lobar.Rheumatic valvular disease might be a risk factor for stroke in young patients with IE,which is an independent risk factor for death of these patients.