儿童感染性心内膜炎临床与超声心动图特点

Clinical features and echocardiography characteristics of infective endocarditis in children

目的探讨儿童感染性心内膜炎(IE)的临床及超声心动图(UCG)特点。方法选择2013年5月至2018年5月,于四川大学华西第二医院确诊的28例IE患儿为研究对象。采用回顾性分析方法,分析其临床病例资料,总结儿童IE的临床及UCG特点。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求,并且与所有患儿监护人签署临床研究知情同意书。结果①临床特点:28例IE患儿中,85.7%(24/28)存在发热症状;血培养阳性率为64.3%(18/28),其中最常见病原体为金黄色葡萄球菌,占血培养阳性结果的33.3%(6/18)。②UCG特点:71.4%(20/28)IE患儿存在先天性心脏病。25例(89.3%,25/28)IE患儿存在心内赘生物,其中2例为多部位受累,其余23例均为单一部位受累。心内赘生物以二尖瓣受累最常见,占检出心内赘生物患儿的40.0%(10/25),二尖瓣前叶及后叶受累各占20.0%(5/25);其次为肺动脉壁近动脉导管开口处及主动脉瓣受累各占16.0%(4/25)。心脏以左房左室增大所占比例最高,为35.7%(10/28)。85.7%(24/28)IE患儿的左心室收缩功能正常。此外,还可出现瓣膜穿孔、反流等。结论儿童IE的临床表现多样化,并且多变,增加了该病的诊断难度。增强对本病的认知,充分掌握其UCG特征,对快速、准确诊断及早期治疗该病,达到改善IE患儿预后的目的十分重要。

Objective To investigate the clinical and ultrasonic cardiogram(UCG)features of children with infective endocarditis(IE).Methods A total of 28 IE children diagnosed in West China Second University Hospital,Sichuan University from May 2013 to May 2018,were selected as research subjects,and the clinical case data of them were analyzed retrospectively to summarize the clinical and UCG characteristics.The procedure followed in this study was in accordance with the World Medical Association Declaration of Helsinki revised in 2013 and informed consents for clinical research were signed with guardians of all children.Results①Clinical features:among 28 children with IE,85.7%(24/28)had fever symptoms;the positive rate of blood culture was 64.3%(18/28),and the most common pathogen was Staphylococcus aureus,which accounted for 33.3%(6/18)in positive blood culture results.②UCG features:71.4%(20/28)of children with IE had congenital heart disease.There were intracardiac vegetations in 25 children with IE(89.3%,25/28),and 2 of them were involved in multiple sites,while the remaining 23 were involved in a single site.Among all children with intracardiac vegetations,mitral valve involvement was the most common,accounting for 40.0%(10/25),and the anterior and posterior mitral leaves were each accounted for 20.0%(5/25).The second place was the pulmonary artery wall near the opening of ductus arteriosus and the aortic valve,which were each accounted for 16.0%(4/25).The highest proportion of heart enlargement was left heart enlargement with proportion of 35.7%(10/28).And 85.7%(24/28)of children with IE had normal left ventricular systolic function.In addition,valve perforation,regurgitation could also be found.Conclusions The clinical manifestations of children with IE were diversified and variable,which increased the difficulty of diagnosis.Enhancing the cognition of IE and fully grasping the characteristics of UCG were very important for rapid and accurate diagnosis and early treatment of the disease,so as to improve the prognosis of children with IE.