感染性心内膜炎患者病原菌分布及心功能指标与感染相关指标表达研究

Distribution of pathogens and expressions of cardiac function indexes and infection related indexes in patients with infective endocarditis

目的分析感染性心内膜炎(IE)患者的病原菌分布特点和心功能情况,总结感染患者的临床特征,为临床IE诊断和治疗提供依据。方法选取2011年1月-2015年11月医院诊治的127例IE患者,总结分析IE患者病原菌鉴定结果,根据细菌培养结果分为阳性组与阴性组,对比血培养阳性者与阴性者间心功能指标、感染相关指标的差异性。结果阳性组患者感染病原菌主要为革兰阳性球菌,其中链球菌属感染率最高(58.3%),其次为金黄色葡萄球菌(14.8%);血培养阳性组患者的左心射血分数(LVEF)、左心室缩短分数(FS)、左室舒张末径(LVEDD)、白细胞计数(WBC)、淋巴细胞计数(LY)、中性粒细胞计数(NEUT)、HGB血红蛋白浓度(HGB)、红细胞沉降率(ESR)、C-反应蛋白(CRP)明显高于阴性组患者;Logistic回归分析显示,心脏病史、心脏赘生物是IE独立危险因素(P<0.05)。结论 IE主要致病菌为革兰阳性球菌,不同血培养结果的IE患者在心功能、感染程度上有较大差异,建议临床应积极进行血培养病原菌鉴定,对于阳性感染者应密切关注心功能、血清感染指标的变化,以准确评估病情转归。

OBJECTIVE To analyze the distribution characteristics and cardiac function of pathogenic bacteria in patients with infective endocarditis（IE）and summarize the clinical characteristics of infected patients,so as to provide the basis for clinical diagnosis and treatment of IE.METHODS A total of 127 patients with IE from Jan.2011 to Nov.2015 were retrospectively analyzed,and were divided into positive group and negative group according to bacterial culture results.The results of pathogen identification of IE patients were analyzed and compared.The differences of the indexes of cardiac function and infection between positive and negative blood cultures were compared.RESULTS In the positive group,the main pathogens were gram-positive bacteria.The infection rate of Streptococcus was the highest（59.3%）,followed by Staphylococcus aureus（14.8%）.The serum LVEF,FS,LVEDD,WBC,LY,NEUT,HGB,ERS,and CRP in the blood culture positive group were significantly higher than those in negative group.Logisticregression analysis showed that cardiac history and cardiac chelator were independent risk factors for IE（P〈0.05）.CONCLUSIONThe major pathogens of IE are gram-positive bacteria,and the differences of heart function and infection degree among IE patients with different blood culture results are significant.It is suggested that the blood culture pathogens should be actively identified,and the changes of cardiac function and serum infection indexes of positive infection should pay attention to accurately assess the outcome of the disease.