CAJ | 학술논문

目的了解近年来感染性心内膜炎(IE)的临床特点变化.方法回顾性分析华山医院近10年收治的97例IE患者的临床资料,包括发病年龄、易感因素、临床表现、血培养及超声心动图检查.计量数值如患者发病年龄等以算术平均数±标准差表示,病例阳性数以百分比表示,对比分析采用Fisher确切概率法.结果 97例IE患者平均年龄(49±17)岁,有基础心脏病73例,占75.3％；前三位是风湿性心脏病27例(27.8％)、先天性心脏病23例(23.7％)、特发性二尖瓣脱垂18例(18.6％).临床表现为发热96例(99.0％)、心脏杂音93例(95.9％)、贫血82例(84.5％).血液细菌培养阳性66例(68.0％),其中草绿色链球菌28株(42.4％),仍为主要致病菌,且全部发生于自然瓣膜心内膜炎患者中；葡萄球菌18株(27.3％),金黄色葡萄球菌10株(15.2％),有3株为耐甲氧西林金黄色葡萄球菌(MRSA),凝固酶阴性葡萄球菌8株(12.1％),有2株为耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)；鲍曼不动杆菌、嗜麦芽窄食单胞菌等耐药性强的病原菌各1株.超声心动图赘生物检出79例,占81.4％,其中右心赘生物9例,病原主要为葡萄球菌.结论 IE患者临床表现、易感因素、致病菌发生了变化,多次血培养及超声心动图检查有助于诊断.
목적 료해근년래감염성심내막염(IE)적림상특점변화.방법 회고성분석화산의원근10년수치적97례IE환자적림상자료,포괄발병년령、역감인소、림상표현、혈배양급초성심동도검사.계량수치여환자발병년령등이산술평균수±표준차표시,병례양성수이백분비표시,대비분석채용Fisher학절개솔법.결과 97례IE환자평균년령(49±17)세,유기출심장병73례,점75.3％；전삼위시풍습성심장병27례(27.8％)、선천성심장병23례(23.7％)、특발성이첨판탈수18례(18.6％).림상표현위발열96례(99.0％)、심장잡음93례(95.9％)、빈혈82례(84.5％).혈액세균배양양성66례(68.0％),기중초록색련구균28주(42.4％),잉위주요치병균,차전부발생우자연판막심내막염환자중；포도구균18주(27.3％),금황색포도구균10주(15.2％),유3주위내갑양서림금황색포도구균(MRSA),응고매음성포도구균8주(12.1％),유2주위내갑양서림응고매음성포도구균(MRCNS)；포만불동간균、기맥아착식단포균등내약성강적병원균각1주.초성심동도췌생물검출79례,점81.4％,기중우심췌생물9례,병원주요위포도구균.결론 IE환자림상표현、역감인소、치병균발생료변화,다차혈배양급초성심동도검사유조우진단.
Objective To analyse the clinical feature of infective endocarditis (IE) in recent years.Methods Clinical profiles including age of onset,predisposing factor,clinical manifestation,blood culture and ultrasonic cardio gram (UCG) of 97 cases from Huashan Hospital in the recent 10 years were collected and analyzed retrospectively. Descriptive data were represented as mean ±standard deviation form.Positive rate was represented as percentage form.Fisher's exact test were used to determine two groups' comparison.Results The mean age of the population was (49±17)years.Seventy-three patients (75.3％) had background heart disease,the top 3 of which was rheumatic heart disease in 27 patients (27.8％),congenital heart disease in 23 patients (23.7％) and idiopathic mitral valve prolapse in 18 patients (18.6 ％).The most common clinical manifestation were fever (99.0％),murmurs (95.9％) and anemia (84.5％).Sixty-six patients (68.0％) had positive result of blood cultures. Streptococcus viridans,which was found in 28 patients with native valve endocarditis (42.4 ％),was still the most common pathogen.Staphylococcus,which was found in 18patients (27.3％),had an elevated ratio.Staphylococcus aureus was found in 10 patients (15.2％)and 3 of which were MRSA.Coagulase-negative staphylococcus was found in 8 patients (12.1 ％ ) and 2 of which were MRCNS. Drug-resistant bacteria was increased and pathogens were varied.Vegetations were found in 79 patients (81.4％) by UCG.Conclusions Clinical manifestation,predisposing factor and pathogen have changed in IE patients. Attaching importance to physical examination,multiple-time blood culture and UCG helps the diagnose of IE.