117例感染性心内膜炎临床及超声心动图特征分析

Clinical and echocardiographic characteristics of 117 cases of infective endocarditis

目的:探讨感染性心内膜炎(IE)患者的临床特点及超声心动图特征。方法:选取2013年1月—2022年12月在湖南省人民医院诊断为IE且超声心动图检出赘生物的117例患者临床及超声心动图影像资料,分析其基础疾病情况、血培养结果、赘生物分布及对瓣膜损毁情况。根据血培养结果将患者分为阳性组与阴性组,对比观察超声心动图结果。结果:117例IE患者中,25例合并先天性心脏病,3例合并风湿性心脏病,4例人工瓣膜置换术后,3例先心病术后。117例IE患者均进行血培养,59例阳性(59/117,50.42%),致病菌主要为链球菌(30/59,50.84%);大部分赘生物分布在左心系统(91/117,77.78%),最常累及二尖瓣(44/117,37.61%)。血培养阳性组与阴性组对比,赘生物分布、瓣膜重度反流、瓣膜损毁及心包积液比较差异均无统计学意义(P>0.05);阴性组>10 mm的赘生物发生率高于阳性组,差异有统计学意义(P<0.05)。结论:超声心动图不仅能直接观察心内赘生物及受累瓣膜损害情况,还能随时了解病变发展和药物治疗效果,为临床诊疗提供依据。

Objective To investigate the clinical and echocardiographic characteristics of patients with infective which endocarditis(IE).Methods The clinical and echocardiographic imaging data of 117 patients diagnosed with IE and vegetations detected by echocardiography in Hunan Provincial People’s Hospital from January 2013 to December 2022 were selected to analyze their underlying diseases,blood culture results,vegetation distribution and valve damage.According to the blood culture results,the patients were divided into positive group and negative group,and the echocardiogram results were compared and observed.Results Among the 117 patients with IE,25 had congenital heart disease,3 had rheumatic heart disease,4 had prosthetic valve replacement,and 3 cases of congenital heart disease were postoperative.All 117 IE patients underwent blood cultures,and 59 patients were positive(59/117,50.42%),and the pathogenic bacteria were mainly streptococcus(30/59,50.84%).Most of the vegetations were distributed in the left heart system(91/117,77.78%),and the mitral valve was most commonly involved(44/117,37.61%).There was no statistically significant difference in the distribution of vegetations,severe valve regurgitation,valve damage,and pericardial effusion between the positive and negative blood culture groups(P>0.05).The incidence of vegetations larger than 10mm in the negative group was higher than that in the positive group,and the difference was statistically significant(P<0.05).Conclusion Echocardiography can not only directly observe the damage of intracardiac vegetations and affected valves,but also understand the development of lesions and the effect of drug treatment at any time,providing a basis for clinical diagnosis and treatment.