经外科手术治疗的右心感染性心内膜炎患者的临床特点

Clinical characteristics of patients with right-sided infective endocarditis treated by surgery

目的分析经外科手术治疗的右心感染性心内膜炎(IE)和左心IE患者的临床资料,以分析右心IE的临床特点。方法回顾性分析2013年8月至2018年12月于北京协和医院行外科手术治疗的右心IE患者的临床症状、超声心动图、病原学、治疗及短期临床转归,并与同期性别、年龄相匹配的左心IE患者进行对比。结果纳入64例右心IE和62例左心IE患者。与左心IE组相比,右心IE组先天性心脏病更常见(75.0%比50.0%,χ2=8.416,P=0.004),更容易出现较大的赘生物(≥20 mm)(50.0%比14.5%,χ2=17.602,P<0.001)。不同于左心IE赘生物多累及心脏瓣膜,右心IE心室内膜赘生物更常见(53.1%比3.2%,χ2=38.422,P<0.001)。在右心和左心IE患者中最常见的病原菌均是草绿色链球菌(37.5%和46.8%),而金黄色葡萄球菌在右心IE组中更常见(15.6%比4.8%,χ2=3.960,P=0.047)。右心IE组中88.9%(8/9)的金黄色葡萄球菌对苯唑西林敏感。所有患者均进行外科手术和术后4~6周的抗感染治疗。左心IE组比右心IE组更容易出现住院期间并发症(29.0%比12.5%,χ2=5.256,P=0.022)。结论先天性心脏病是右心IE最常见的易患因素。草绿色链球菌是IE最常见的病原菌。相比于左心IE,在右心IE中金黄色葡萄球菌更常见,抗感染联合外科手术治疗有较好的短期临床转归。

Objective To analyze the clinical characteristics of patients with right-sided infective endocarditis(RSIE)and left-sided IE(LSIE)under surgery.Methods The clinical symptoms,echocardiographic parameters,microbiologic features,therapy and short-term clinical outcomes of RSIE patients under surgery were analyzed retrospectively from August 2013 to December 2018 in Peking Union Medical College Hospital.LSIE patients were matched according with sex and age in the same period.Results 64 RSIE patients and 62 LSIE patients were finally enrolled.Compared with LSIE group,congenital heart disease(75.0%vs.50.0%,χ2=8.416,P=0.004)and large vegetation which was greater or equal to 20 mm(50.0%vs.14.5%,χ2=17.602,P<0.001)were more common in the RSIE group.Valvular vegetation was more common in the LSIE group,while ventricular mural vegetation was more frequent in the RSIE group(53.1%vs.3.2%,χ2=38.422,P<0.001).The most common pathogen in both groups was Streptococcus viridans(37.5%and 46.8%,respectively),while Staphylococcus aureus was more reported in the RSIE group(15.6%vs.4.8%,χ2=3.960,P=0.047).88.9%of Staphylococcus aureus was sensitive to Oxacilin in the RSIE group.All patients underwent surgery and received intravenous antimicrobial treatment at least 4 to 6 weeks.In-hospital complication was more frequently observed in the LSIE group(29.0%vs.12.5%,χ2=5.256,P=0.022).Conclusions Congenital heart disease was the most common predisposing factor in RSIE.Streptococcus viridans was the most common pathogen.Staphylococcus aureus was more reported in the RSIE compared with LSIE.Antimicrobial treatment combined with surgery may have a better short-term outcome.