无心脏疾病感染性心内膜炎患者的临床特征及病原菌分析

Clinical characteristics and pathogen analysis of infective endocarditis patients with no heart disease

目的 探讨无心脏疾病感染性心内膜炎（NHDIE）患者的临床特征及病原菌分布.方法 收集2010年8月至2016年12月浙江省人民医院确诊的感染性心内膜炎患者共86例,分为NHDIE（49例）和有心脏疾病（HDIE）组（37例）.比较两组基础疾病、实验室检查、手术情况及病原菌分布和耐药情况.结果NHDIE组患者贫血、二尖瓣累及率分别为71.4％和65.3％,明显高于HDIE组（x2=4.626、12.363,P＜0.05）.NHDIE组有22例患者接受瓣膜置换或成形术治疗,比例高于HDIE组（x2=3.188,P＜0.05）;但病死率两组差异无统计学意义（12.2％∶18.9％,x2=0.732,P＞0.05）.NHDIE患者感染的主要病原菌为链球菌属（16株）,其次为金黄色葡萄球菌和凝固酶阴性葡萄球菌各4株.链球菌耐药较高的前3种药物依次为四环素（6/8）、复方磺胺甲噁唑（6/8）、红霉素（9/14）;2株金黄色葡萄球菌对红霉素、克林霉素、青霉素G耐药,4株凝固酶阴性葡萄球菌均对青霉素G和苯唑西林耐药.结论 NHDIE患者常存在贫血、累及二尖瓣等表现,手术治疗预后仍较差;感染菌株耐药现象普遍.

Objective To investigate clinical features of infective endocarditis （IE） patients with no heart diseases （NHDIE）,and to analyze the distribution of pathogenic bacteria.Methods A total of 86 IE patients diagnosed in Zhejiang Provincial People＇s Hospital from August 2010 to December 2016 were collected.They were divided into NHDIE group （49 cases） and IE with heart disease （HDIE） group （37 cases）.The basic diseases,laboratory inspection,operation condition as well as distribution and drug resistance of pathogenic bacteria in two groups were compared.Results The incidence of anemia （71.4％） and the rate of mitral valve involvement（65.3％） in NHDIE group were higher than those in HDIE group （x2=4.626,12.363,P＜0.05）.There were 22 cases in NHDIE group accepting valve replacement or valvoplasty,and the proportion was higher than that in HDIE group（x2=3.188,P＜0.05）.However,the difference of mortality rates between two groups had no statistical significance（12.2％ ∶ 18.9％,x2=0.732,P＞0.05）.The main pathogens in NHDIE group were Streptococcus （16 strains）,followed by Staphylococcus aureus （4 strains） and coagulase negative Staphylococcus （4 strains）.The top 3 antibiotics with high drug resistance in Streptococcus strains were tetracycline （6/8）,compound sulfamethoxazole （6/8） and erythrocin （9/14）.Two Staphylococcus strains were resistant to erythrocin,clindamycin and penicillin G,while 4 coagulase negative Staphylococcus strains were resistant to penicillin G and oxacillin.Conclusions The majority of IE patients without heart disease are characterized by anemia and the involvement of mitral valve,and the prognosis is poor.The strains are commonly drug resistant.