肥厚型梗阻性心肌病合并感染性心内膜炎14例临床分析

Clinical analysis of 14 infective endocarditis in patients with obstructive hypertrophic cardiomyopathy

目的:探讨肥厚型心肌病合并感染性心内膜炎(IE)病例的临床特征。方法:2006年8月至2018年6月阜外医院收治肥厚型心肌病(HCM)患者7427例,IE患者668例,其中HCM合并IE者14例,回顾性分析其临床特征,描述14例患者的临床表现、病原学特征、超声心动图发现、治疗及出院转归等。结果:HCM合并IE发生率为0.19%,在HCM患者中IE的发病率为0.15/1000人年;HCM合并IE 14例患者中男性占11例,发热及心脏杂音是最常见的临床表现;心功能不全(12/14)及细菌性栓塞(8/14)为最常见并发症;致病微生物均为革兰阳性球菌,以链球菌最常见(5/8);超声心动图提示室间隔厚度(21.2±2.7)mm,左心室流出道梗阻重,14例均有赘生物形成,赘生物最多分布于二尖瓣前叶(12/14),体循环栓塞(8/14)及瓣叶损害(12/14)发生率高;好转出院10例,其中8例为接受外科手术治疗者;2例自动出院后死亡,2例院内死亡。结论:HCM合并IE发生率低,HCM合并IE患者细菌性栓塞及瓣叶损害的发生率较高,且住院病死率高,预后较差,外科手术是治疗HCM合并IE成功的基石。

Objective This observational study was aimed to analyze the clinical characteristics of infective endocarditis(IE)in patients with hypertrophic cardiomyopathy(HCM).Methods A total of 668 patients with IE,and 7427 patients with HCM were treated in Fuwai Hospital from August 2006 to December 2018.Among them,14 patients were diagnosed with HCM and IE.The clinical characteristics of these patients including clinical manifestations,pathogen distribution,echocardiography features,in-hospital treatment and outcomes were analyzed retrospectively.Results The proportion of HCM patients with IE was 0.19%,with the estimated incidence of 0.15/1000 person-years in HCM patients.Of the 14 patients,11 patients were male.The most common clinical manifestations were fever and heart murmur,and the main complications were heart failure(12/14)and bacterial embolism(8/14).There were 8 cases(8/14)with positive blood culture,and all causative bacteria were gram positive coccus,in which 5/8 were Streptococcus.The median interventricular septum thickness was(21.2±2.7)mm,and left ventricular outflow obstruction was severe based on echocardiography(Echo)examination.The Echo showed that vegetation was found in all 14 patients and most of the vegetation attached at the anterior leaflet of mitral valve(12/14).The proportions of patients with circulatory embolism(8/14)and valve lesions(12/14)were relatively high.Most cases(10/14)were cured,especially those underwent cardiac surgery(8 cases).The rest 4 cases died with 2 in hospital and 2 after auto-discharge.Conclusions HCM patients complicated with IE are rare.Septic embolization and valve lesions are common in these patients.IE patients with HCM might have a poor prognosis compared to those without HCM and should receive cardiac surgery as early as possible.