157例感染性心内膜炎患者的病原菌构成及临床特点分析

Analysis of Pathogens and Clinical Characteristics in 157 Cases with Infective Endocarditis

目的总结分析感染性心内膜炎培养阳性病例的临床特点,为临床合理诊治提供依据。方法收集2008年1月至2015年8月住院的符合Duke标准且培养阳性的157例感染性心内膜炎患者的临床资料进行回顾性分析。结果 157例患者平均发病年龄为40.85岁,101例(64.3%)存在各种基础心脏病,其中以先天性心脏病为主[44例(28.0%)],风湿性心脏病15例(9.6%)。临床表现以贫血(147例,93.6%)、发热(137例,87.3%)、心脏杂音(120例,76.4%)为主。12例(7.6%)经胸壁心脏超声(TTE)未发现赘生物而经食管心脏超声(TEE)发现赘生物。链球菌感染76例(48.4%)居首位(其中草绿色链球菌70例),其次为葡萄球菌感染33例(21.0%)(其中金黄色葡萄球菌18例,11.5%)。所有患者均给予抗菌药物治疗。85例(54.1%)患者接受了手术治疗,其中72例进行了换瓣手术。27例患者痊愈出院,88例患者显效,38例患者无效,4例患者死亡。其中手术组疗效优于非手术组(P<0.05)。结论感染性心内膜炎的特点包括发病年龄较往年增大,基础疾病以先天性心脏病为主,发热仍是主要的临床表现之一,草绿色链球菌是最常见的病原体。外科手术治疗可有效改善患者预后。

Objective To analyze the clinical characteristics of infective endocarditis （IE） in culture-positlve patients, so as to provide the evidences for reasonable diagnosis and treatment of IE. Methods We performed a retrospective study of 157 culture-positive IE cases, which were diagnosed according to modified Duke criteria for IE from Jan. 2008 to Aug. 2015. Results The average age of 157 cases of IE was 40.85 years. One hundred and one patients （64.3%） had various underlying cardiac diseases, including congenital cardiovascular diseases in 44 cases and rheumatic heart diseases in 15 cases. The main clinical manifestations were anemia （147 cases, 93.6%）, fever （137 cases, 87.3%） and heart murmur （120 cases, 76.4%）. Vegetation was found in 12 cases （7. 6%） with transesophageal echocardiography （TEE） but not with transthoracic echocardiography （TTE）. Culture results showed the most common causative microorganisms were Streptococci （76 cases, 48. 4%）, with Viridans streptococci dominated in 70 cases, and Staphylococci （33 cases, 21.0%） （Staphylococcus aureus dominated in 18 cases）. All patients were treated with antimicrobial agents. Eighty-five patients （54. 1%） received surgical intervention, of which 72 cases received valve replacement. Twenty-seven patients were cured, 88 patients were markedly improved, 38 patients discontinued treatment, and 4 patients died. The therapeutic efficacy of operation group was better. Conclusion The clinical characteristics of IE included., the age of Onset increased, congenital heart disease was the most underlying disease, and Viridians streptococci was the most popular causative microorganism. Surgical therapy can effectively improve the outcomes of IE patients.