真菌性心内膜炎临床特征及治疗方案选择

Characteristics and treatment for fungal endocarditis

目的通过对真菌性心内膜炎患者的临床特征、治疗方案等分析,为其早期诊断与治疗提供参考。方法对广东省人民医院2012年4月至2017年4月收治的14例真菌性心内膜炎患者的临床资料进行回顾性分析。结果14例真菌性心内膜炎患者中,5例(35.7%)有风湿性心脏病,6例(42.9%)曾行瓣膜置换术,50%出现栓塞并发症,病原菌均为念珠菌属,主要为近平滑念珠菌(42.9%)。出院1个月病死率为38.5%,一年内病死率为53.8%。治疗方式上,50%接受了外科手术治疗,50%单纯药物治疗,两组患者病死率比较,差异无统计学意义(28.6%vs.83.3%,P=0.103)。结论真菌性心内膜炎在风湿性心脏病和瓣膜置换术病史患者中多见,病死率高,需根据患者具体情况权衡利弊,选择最佳治疗方式。

Objectives To explore the general characteristics,treatment patterns and outcomes of patients with fungal endocarditis(FE),in order to provide reference for its diagnosis and treatment.Methods Totally 14 patients with FE were admitted from April 2012 to April 2017 in Guangdong Provincial People's Hospital.Clinical characteristics were retrospectively analyzed.Results Of these patients,5(35.7%)patients had a rheumatic heart disease,6(42.9%)had a history of valvular replacement.50%of the patients experienced embolic events.Candida remained the predomi⁃nant causative pathogen.Candida parapsilosis accounted for 6 cases(42.9%).1-month mortality rate was 38.5%and 1-year mortality rate was 53.8%.The study revealed that better outcomes were associated with a combined surgical and medical therapy approach,but the difference of mortality rate was not statistically significant(28.6%vs.83.3%,P=0.103).Conclusions FE is associated with high mortality.Major risk factors have been found to be underlying valve disease and previous valve surgery.The suitable treatment for FE is individual comprehensive therapy.