单中心十年收治感染性心内膜炎患儿临床分析

Single center study on clinical features of children with infective endocarditis during the past 10 years

目的 探讨单中心10年来收治的感染性心内膜炎（infective endocarditis,IE）患儿的临床特点、病原菌分布等情况,为临床诊治提供参考.方法 回顾性分析中国医科大学附属盛京医院2006年10月至2016年10月儿科病房住院治疗的30例确诊 IE 患儿的临床及病原学资料.结果30例IE 患儿中,男18例,女12例,年龄2个月~13岁.IE就诊原因分别为发热21例（70.0%）,呼吸系统症状4例（13.3%）,神经系统症状4例（13.3%）,水肿2例（6.7%）,新发心脏杂音1例,心前区不适1例,血三系减少1例.基础疾病所占比例最高的是先天性心脏病17例（56.7%）,其中6例为先天性心脏病术后患儿.30例患儿心脏彩超均发现赘生物,血细菌培养阳性15例（50.0%）,病原菌分布：金黄色葡萄球菌6例（40.0%）,肺炎链球菌4例（26.7%）,粪肠球菌2例（13.3%）,血链球菌1例,咽颊炎链球菌1例,表皮葡萄球菌1例.入院时C-反应蛋白升高25例（83.3%）,其中8例C-反应蛋白〉100 mg/L.结论 IE早期临床症状多不典型,发热是IE的常见就诊原因,先天性心脏结构异常易并发IE,革兰阳性球菌是主要致病原,单纯抗感染治疗效果不佳者可联合手术治疗.

Objective To investigate the clinical features,pathogenic distribution of children with in-fective endocarditis（IE）during the past 10 years.Methods Medical records of 30 children with IE admitted to Shengjing Hospital of China Medical University from October 2006 to October 2016 were retrospectively analyzed,including the clinical data and pathogenic characteristics.Results Among the 30 cases of IE,there were 18 males and 12 females,age ranged from 2 months to 13 years old.Fever was found as initial symp-toms in 21 cases（70.0%）,respiratory symptoms in 4 cases（13.3%）,neurological symptoms in 4 cases （13.3%）,edema in 2 cases（6.7%）,murmur in 1 case,precordial discomfort in 1 case,and peripheral blood cell reduction in 1 case. The most common underlying factor was congenital heart disease（17 cases, 56.7%）.Surgery was performed in 6 children due to congenital heart disease before endocarditis.Vegetations were detected on echocardiography in all cases（100%）.Blood cultures were positive in 50.0%,Staphylococ-cus aureus was the most common organism,accounting for 6 cases （40.0%）.Other notable pathogens in-cluded Streptococcus pneumoniae（4 cases,26.7%）,Enterococcus faecalis（2 cases,13.3%）,Streptococcus suis（1 case）,Streptococcus anginosus（1 case） and Staphylococcus epidermidis（1 case）.C-reactive protein was raised in 25 cases（83.3%）at the time of admission.C-reactive protein was higher than 100 mg/L in 8 cases.Conclusion Early clinical manifestations of IE are atypical.Fever is the most common symptom. Congenital heart disease is the major risk factor of IE,Gram-positive cocci is the most common organism. Antibiotic treatment is not effective,then surgical treatment may be considered.