湘雅医院430例感染性心内膜炎患者的临床特征及治疗

Clinical characteristics and treatment of 430 patients with infective endocarditis in Xiangya Hospital

目的了解感染性心内膜炎(IE)患者的临床特征、治疗方法和预后,为IE早期诊断及治疗提供参考依据。方法回顾性分析湘雅医院2009年1月—2017年12月确诊的IE患者临床资料、分离病原微生物、治疗方法及预后。结果共纳入符合诊断标准的IE患者430例,男性多见(289例,占比67.2%),平均年龄在(40.3±15.1)岁。无基础心脏病患者284例(66.0%),有基础心脏病患者146例(34.0%);基础心脏病中先天性心脏病115例(26.7%),风湿性心脏病23例(5.3%),非风湿性心瓣膜病8例(1.9%)。IE患者临床表现主要为发热336例(78.1%)、贫血381例(88.6%)及心脏杂音383例(89.1%);最常见的并发症为栓塞(21.4%),其次为心力衰竭(18.8%)。IE患者中瓣膜脱垂151例,瓣膜狭窄88例,瓣膜关闭不全347例,最常见为主动脉瓣关闭不全(134例),有两个或以上瓣膜关闭不全者72例;血培养阳性率44.9%,其中链球菌属为最常见的致病微生物(119株,61.7%),其次为葡萄球菌属(41株,21.2%)。IE患者手术治疗319例(74.2%),住院病死率10.2%,药物治疗联合手术治疗患者治愈好转率高于单纯药物治疗患者(95.3%VS 64.9%,P<0.001)。结论目前IE患者以无基础心脏病患者较常见,最常见的致病菌为链球菌属,抗感染治疗是IE的治疗基础,尽早联合手术治疗可降低患者住院病死率。

Objective To understand the clinical characteristics,treatment and prognosis of patients with infective endocarditis(IE),and provide reference for the early diagnosis and treatment of IE.Methods Clinical data,isolated pathogens,treatment and prognosis of patients with IE diagnosed in Xiangya Hospital from January 2009 to December 2009 were analyzed retrospectively.Results A total of 430 patients who met the diagnostic criteria of IE were included,most of them were males(n=289,67.2%).The average age was(40.3±15.1)years.284 patients(66.0%)had no underlying heart disease,146(34.0%)had underlying heart disease,115(26.7%)had congenital heart disease,23(5.3%)had rheumatic heart disease,and 8(1.9%)had non-rheumatic heart valve disease.The main clinical manifestations of IE were fever(n=336,78.1%),anemia(n=381,88.6%)and heart murmur(n=383,89.1%);the most common complication was embolism(21.4%),followed by heart failure(18.8%).There were 151 cases of valve prolapse,88 cases of valve stenosis,347 cases of valve insufficiency,mostly were aortic valve insufficiency(n=134),72 cases were with two or more valve insufficiency;positive rate of blood culture was 44.9%,Streptococcus spp.was the most common pathogen(119 strains,61.7%),followed by Staphylococcus spp.,(41 strains,21.2%).319 patients(74.2%)with IE were operated,mortality was 10.2%,the recovery rate of patients receiving drug therapy combined with surgery was higher than that of patients only receiving drug therapy(95.3%vs 64.9%,P<0.001).Conclusion At present,IE is common in patients with underlying heart disease,the most common pathogen is Streptococcus spp.,anti-infective treatment is the basis of IE treatment,early surgery can reduce the in-hospital mortality.