CAJ | 학술논문

目的探讨早期手术对左心自体瓣膜感染性心内膜炎(IE)患者长期预后的影响.方法入选2002-2012年北京协和医院收治的左心自体瓣膜IE患者共239例.采用倾向评分对早期手术组及传统治疗组进行匹配.结果 70例(29.3％)行早期手术,169例(70.7％)接受传统治疗.中位随访时间2年.早期手术组IE相关病死率显著低于传统治疗组(10.0％比23.1％,P=0.02).对58对倾向评分匹配队列行生存分析,结果显示早期手术组未发生IE相关死亡的累积生存率显著高于传统治疗组(P=0.027).回归分析显示,早期手术是降低IE相关死亡风险的独立预测因子(HR0.286,95％ CI0.092 ～0.893,P=0.031),纽约心脏病协会(NYHA)心功能分级Ⅲ～Ⅳ级(HR4.044,95％ CI1.318 ～ 12.407,P=0.015)和未控制的感染(HR 52.064,95％ CI 10.996 ～247.194,P＜0.001)是IE相关死亡增加的独立预测因子.结论早期手术与传统治疗相比,可显著改善左心自体瓣膜IE患者的长期预后.心功能不全和未控制的感染则是增加IE死亡的危险因素.
목적 탐토조기수술대좌심자체판막감염성심내막염(IE)환자장기예후적영향.방법 입선2002-2012년북경협화의원수치적좌심자체판막IE환자공239례.채용경향평분대조기수술조급전통치료조진행필배.결과 70례(29.3％)행조기수술,169례(70.7％)접수전통치료.중위수방시간2년.조기수술조IE상관병사솔현저저우전통치료조(10.0％비23.1％,P=0.02).대58대경향평분필배대렬행생존분석,결과현시조기수술조미발생IE상관사망적루적생존솔현저고우전통치료조(P=0.027).회귀분석현시,조기수술시강저IE상관사망풍험적독립예측인자(HR0.286,95％ CI0.092 ～0.893,P=0.031),뉴약심장병협회(NYHA)심공능분급Ⅲ～Ⅳ급(HR4.044,95％ CI1.318 ～ 12.407,P=0.015)화미공제적감염(HR 52.064,95％ CI 10.996 ～247.194,P＜0.001)시IE상관사망증가적독립예측인자.결론 조기수술여전통치료상비,가현저개선좌심자체판막IE환자적장기예후.심공능불전화미공제적감염칙시증가IE사망적위험인소.
Objective This study aims to evaluate the impact of early surgery on long-term outcome of patients with left-sided native valve infective endocarditis (IE).Methods Clinical data were retrospectively reviewed in 239 consecutive patients with left-sided native valve IE from 2002 to 2012 in Peking Union Medical College Hospital (PUMCH).Propensity score was used to match patients in the early operation and conventional treatment groups.Results Early surgery was performed in 70 (29.3％)patients and the conventional treatment strategy was applied in 169 (70.7％) patients.The median followup period was 2 years.IE-related mortality was lower in the early operation group than in the conventional treatment group (10.0％ vs 23.1％,P =0.02).For 58 propensity score-matched pairs,the cumulative survival free from IE related death was significantly higher in the early operation group than in the conventional treatment group (P =0.027).Regression analysis of the matched cohorts revealed that early surgery was independently associated with decreased IE-related mortality (HR 0.286 ; 95％ CI 0.092-0.893 ;P =0.031).While either cardiac function with NYHA Class Ⅲ-Ⅳ (HR 4.044; 95％ CI 1.318-12.407;P =0.015) or uncontrolled infection (HR 52.064; 95％ CI 10.996-247.194; P ＜ 0.001) was associated with poor prognosis of increased mortality.Conclusions Early surgery improved long-term outcome in patients with left-sided native valve IE compared with conventional therapy.Risk factors related to increased mortality included heart failure and uncontrollable infection.