布氏菌性心内膜炎六例临床特点分析并文献复习

A clinical analysis of six patients with Brucella endocarditis and literature review

目的分析布氏菌性心内膜炎的临床特点，以提高临床医生对本病的诊断及治疗水平。方法回顾性分析2007年5月至2016年12月北京协和医院收治的布氏菌性心内膜炎的患者，分析流行病学资料、临床特点、实验室及心脏彩色超声检查结果、治疗方法及预后等信息。结果211例血培养生长布氏菌的患者中，6例诊断为布氏菌性心内膜炎，发生率为2.8%。此6例患者中5例为男性，年龄25～55岁，均有牛、羊等动物接触史。所有患者均发热，3例伴关节疼痛；4例患者累及主动脉瓣，其中2例患者入院时出现重度主动脉关闭不全，并伴有心功能不全。6例患者布氏菌血清凝集试验均为阳性。所有患者均接受抗菌药物长程治疗。接受瓣膜置换术患者4例，其中3例患者均存活，恢复良好，1例患者失访。6例患者中4例在继续随访，2例失访。结论布氏菌性心内膜炎常累及主动脉瓣，易引起心功能不全。早期有效的抗菌治疗联合瓣膜置换手术是有限的治疗措施。

ObjectiveTo analyze the epidemiology and clinical characteristics of patients with Brucella endocarditis in order to improve the understanding and treatment of Brucella endocarditis.MethodsThe clinical data including demographic characteristics, clinical features, laboratory data, echocardiography, treatment and clinical outcome of 6 patients with Brucella endocarditis were collected and analyzed.ResultsIn our database consisting of 211 brucellosis patients with positive blood culture, 6 patients （2.8%） with Brucella endocarditis were selected from May 2007 to December 2016 in Peking Union Medical College Hospital.The age range was 25-55 years, among whom 5 patients were men.The majority were farmers and all patients reported the history of closely contact with livestock.All of them had fever and 3 of them had arthralgia.Four patients had aortic involvement （4/6） and 2 of them presented with symptoms of left ventricular failure at admission.Blood culture of Brucella and serum agglutination test of Brucella were positive in all of them.Combined antibiotics treatments were given to all patients.Valve replacement surgery was performed in four patients, among them, three patients well recovered, one lost. Among all the patients, four were followed up continually and other two were lost.ConclusionsBrucella endocarditis has a predominance of aortic involvement and is prone to left ventricular failure.Early antibiotic treatment combined with valve-replacement surgery is effective to improve the prognosis.