单纯右心感染性心内膜炎临床特征分析

Analysis of clinical characteristics of isolated right-sided infective endocarditis

目的探讨右心感染性心内膜炎(right-sided infective endocarditis,RSIE)患者的临床特征,提高对RSIE的认识。方法选取2011年1月至2018年12月中国医学科学院北京协和医院诊断为RSIE的住院患者60例,对其临床资料进行回顾性分析,并与同期左心感染性心内膜炎(left-sided infective endocarditis,LSIE)进行对比。结果60例RSIE占同时期住院感染性心内膜炎(infective endocarditis,IE)患者的14.1%(60/425)。从发病至确诊的中位时间为13周。发热是最常见的临床表现(100.0%,60/60),48例(80.0%)有肺部受累表现。易患因素中,先天性心脏病居首位,占71.7%(43/60)。血培养和(或)瓣膜赘生物培养阳性有49例(81.7%),以草绿色链球菌和葡萄球菌为主。56例(93.3%)超声心动图检查发现赘生物。所有患者给予抗感染治疗,其中48例(80.0%)联合手术治疗,无院内死亡病例。与LSIE患者相比,RSIE患者年龄更小[(38.0±14.0)岁比(46.0±15.0)岁],女性更常见(51.7%比31.4%),有易患因素的比例更高(78.3%比55.0%),而发生充血性心力衰竭的比例则较低(25.0%比55.6%),链球菌感染的比例较低(49.9%比69.4%),葡萄球菌感染比例较高(28.6%比10.3%),脓肿形成的比例较低(0例比31例),差异均有统计学意义(P<0.05)。结论RSIE仍存在明显的诊断延误,对于有RSIE易患因素的患者,若出现发热和肺部受累表现,应积极行血培养与超声心动图检查,以达到早诊断、早治疗的目的。

Objective To investigate the clinical characteristics of patients with right-sided infective endocarditis(RSIE),and to improve the understanding of RSIE.Methods A total of 60 inpatients diagnosed with RSIE in Peking Union Medical College Hospital,Chinese Academy of Medical Sciences from January 2011 to December 2018 were selected and their clinical data were retrospectively analyzed.They were compared with left-sided infective endocarditis(LSIE)at the same time.Results The 60 cases of RSIE accounted for 14.1%(60/425)of infective endocarditis(IE)patients hospitalized during the same period.The median time from onset to diagnosis was 13 weeks.Fever was the most common clinical presentation(100.0%,60/60),with pulmonary involvement in 48 cases(80.0%).Congenital heart disease ranked first among the risk factors,accounting for 71.7%(43/60).The 49 cases(81.7%)with positive blood culture and/or valvular vegetation culture were mainly streptococcus viridans and staphylococcus.Vegetation were found on echocardiography in 56 cases(93.3%).All patients were given anti-infective treatment,of which 48 cases(80.0%)were treated with surgery,and there were no deaths in the hospital.Compared with LSIE patients,RSIE patients were younger[(38.0±14.0)years vs.(46.0±15.0)years],more common in women(51.7%vs.31.4%),and had a higher proportion of predisposing factors(78.3%vs.55.0%),the incidence of congestive heart failure was lower(25.0%vs.55.6%),the incidence of Streptococcus infection was lower(49.9%vs.69.4%),the incidence of Staphylococcus infection was higher(28.6%vs.10.3%),and the incidence of abscess formation was lower(0 cases vs.31 cases),the differences were statistically significant(P<0.05).Conclusions There is still a significant delay in the diagnosis of RSIE.For patients with RSIE risk factors,if fever and pulmonary involvement appear,blood culture and echocardiography should be actively performed to achieve the purpose of early diagnosis and early treatment.