发生栓塞事件的感染性心内膜炎患者临床特点及危险因素分析

Analysis of clinical profile and predictors of embolic events in patients with infective endocarditis

目的:分析发生栓塞事件(EE)的感染性心内膜炎(IE)患者的临床特点及危险因素。方法:纳入2018年至2019年,我院诊断为IE的患者,随访至患者出院。比较IE合并EE与IE不合并EE两组患者临床各项指标的差异。结果:(1) IE患者EE发生率为20.9%,合并EE的IE患者平均年龄为49岁,男性占65.5%,自体瓣膜占79.3%,二尖瓣受累者占51.7%,赘生物大小平均为14.82 mm,病原微生物以葡萄球菌属及链球菌属为主,栓塞部位以中枢神经系统最为常见;(2)单因素分析显示:女性(OR=2.52,95%CI:1.01~6.27,P <0.047)、大的赘生物(OR=1.13,95%CI:1.02~1.22,P <0.001)、WBC≥15×109/L(OR=11.25,95%CI:2.06~61.49,P <0.005)、升高的CRP(OR=1.01,95%CI:1.01~1.02,P <0.001)以及血培养阳性(OR=2.48,95%CI:1.08~5.71,P <0.033)为栓塞事件的危险因素,而MPV增大(OR=0.74,95%CI:0.55~0.99,P <0.05)及高的LDL-C水平(OR=0.66,95%CI:0.46~0.94,P <0.05)为栓塞事件的保护因素;(3)多因素分析结果表明:大的赘生物(OR=1.11,95%CI:1.02~1.20,P<0.05)及WBC≥15×109/L(OR=11.68,95%CI:1.38~98.71,P <0.05)为IE患者EE的危险因素。结论:大的瓣膜赘生物及外周血WBC≥15×109/L是IE患者EE的危险因素。

Objective:To analyze the clinical profile and predictors of embolic events(EE) in patients with infective endocarditis(IE).Methods:Patients diagnosed with IE in our hospital from 2018 to 2019 were included and followed up until they discharged.Analysis and comparison of differences in clinical indicators between IE with EE and IE without EE applied.Results:(1) The incidence of EE in IE patients was 20.86%.The average age of IE patients with EE was 49 years old,65.5% were male,79.3% were native valves,51.72%were mitral valve involvement,and the average size of vegetation was 14.82 mm.Staphylococcus spp.and Streptococcus spp.were the most common pathogens,and the most common site of embolism was the central nervous system.(2) Univariate analysis showed that female(OR=2.52,95% CI:1.01-6.27,P < 0.047),larger vegetation(OR=1.13,95% CI:1.02-1.22,P < 0.001),white blood cell count ≥ 15×109/L(OR=11.25,95% CI:2.06-61.49,P < 0.005),elevated C-reactive protein(OR=1.01,95% CI:1.01-1.02,P < 0.001),and positive blood culture(OR=2.48,95% CI:1.08-5.71,P < 0.033) were risk factors for embolic events,while increased mean platelet volume(OR=0.74,95%:CI:0.55-0.99,P < 0.041) and high LDL levels(OR=0.66,95% CI:0.46-0.94,P < 0.020) were a protective factor for embolic events.(3) The results of multivariate analysis showed that larger vegetation(OR=1.11,95% CI:1.02-1.20,P < 0.015) and WBC count ≥ 15×109/L(OR=11.68,95% CI:1.38-98.71,P < 0.024) were predictors for EE in IE patients.