2020 年第 3 期 第 15 卷

二尖瓣主动脉瓣感染性心内膜炎临床特点及术后疗效分析

Clinical features and postoperative prognosis of mitral and aortic valve infective endocarditis

作者：贾一琼朱光发

英文作者：

单位：首都医科大学附属北京安贞医院感染科100029

英文单位：

关键词：感染性心内膜炎；临床特点；心脏手术；预后

英文关键词：

• 摘要：

• 【摘要】目的    探讨接受心脏手术治疗的左心自体瓣膜感染性心内膜炎（IE）患者的临床表现、实验室检查结果、超声心动图、病原菌分布以及术后长期预后。方法    回顾性分析2012年12月至2017年5月在首都医科大学附属北京安贞医院进行手术治疗的200例IE患者的病例资料，根据瓣膜受累情况分为103例单独二尖瓣受累IE患者(M组)和97例单独主动脉瓣受累IE患者(A组)。比较2组基本资料、临床症状、相关实验室检查结果、致病菌分布、手术适应证和手术时机，并进行长期随访观察术后生存率。结果    M组以发热为首发症状更常见［83.5%（86/103）比67.0%（65/97），P＝0.007］，A组以胸闷憋气为首发症状者多于M组［26.8%（26/97）比11.7%（12/103），P＝0.006］。A组纽约心脏病协会心功能分级 Ⅲ 级、左心室射血分数＜55%的患者明显多于M组［57.7%（56/97）比43.7%（45/103）、22.7%（22/97）比3.9%（4/103）］，差异均有统计学意义（P＝0.004，P＜0.001）。A组既往有先天性心脏病史者明显多于M组［51.5%（50/97）比8.7%（9/103）］，差异有统计学意义（P＜0.001）。金黄色葡萄球菌和草绿色链球菌分别是A组、M组最常见致病菌。IE最常见的手术适应证是心脏衰竭和大赘生物，A组中心脏衰竭、瓣周脓肿形成均较M组多见。A组术后长期生存率低于M组,但差异无统计学意义(P＝0.057)。结论    单独主动脉瓣受累IE患者相关临床症状及心功能较单独二尖瓣受累IE患者更严重，二者病原菌分布和预后均有差异。

  
  

• 【Abstract】Objective    To investigate the clinical features, laboratory results, echocardiography, pathogenic distribution and long-term prognosis of left heart autogenous valve infective endocarditis(IE). Methods    Clinical data of 200 IE patients who underwent surgery in Beijing Anzhen Hospital， Capital Medical University from December 2012 to May 2017 were retrospectively analyzed. The patients were divided into group M(mitral valve infective endocarditis, n＝103) and group A(aortic valve infective endocarditis, n＝97). General information, clinical symptoms, laboratory tests, pathogenic bacteria distribution, surgical indication and timing were analyzed. Postoperative survival was observed during long-term follow-up. Results    Fervescence was a common initial symptom in group M［83.5%（86/103）vs 67.0%（65/97） in group A, P＝0.007］.Chest tightness and breath shortness were common in group A［26.8%（26/97）vs 11.7%（12/103）in group M, P＝0.006］. In group A there were more patients with New York Heart Association cardiac function grade Ⅲ, left ventricular ejection fraction＜55% and congenital heart disease history［57.7%（56/97）vs 43.7%（45/103）, 22.7%（22/97）vs 3.9%（4/103）, 51.5%（50/97）vs 8.7%（9/103）］（P＝0.004, P＜0.001, P＜0.001）. Staphylococcus aureus and Streptococcus viridians were the main pathogens in group A and group M, respectively. Heart failure and large vegetations were the main surgical indications of IE; heart failure and perivalvular abscess were more common in group A than in group M. The long-term survival rate in group A was lower than that in group M, but the difference was not statistically significant(P＝0.057). Conclusion    Clinical symptoms and cardiac function in aortic valve infective endocarditis are more severe than in mitral valve infective endocarditis; pathogen distribution and postoperative prognosis are different.