CAJ | 학술논문

目的分析先天性心脏病(先心病)合并感染性心内膜炎患者的发病特点,了解易发生感染性心内膜炎的先心病类型及临床诊疗情况.方法收集1998至2009年阜外心血管病医院经外科手术切除、病理学确诊的先心病合并感染性心内膜炎的病例,收集患者的相关临床资料.分析临床诊断与病理学诊断的符合率及病理学表现与超声心动图检查的符合率.结果 1998至2009年病理学诊断先心病合并感染性心内膜炎74例,占同期所有外科矫治感染性心内膜炎患者的33.6％(74/220).患者平均年龄(32.8±13.8)岁.在未矫治先心病合并感染性心内膜炎患者中最常见的先心病类型为主动脉瓣二叶化畸形,占52.2％(35/67),患者年龄(37.5±12.5)岁,高于其他先心病合并感染性心内膜炎患者年龄[(30.0±16.6)岁,P=0.017].感染主要位于左侧房室瓣或大动脉瓣(83.8％,62/74),主动脉瓣是受累最多的部位,其中单独受累47例(75.8％,47/62).74例患者均行经胸超声心动图检查,阳性诊断率为66.3％(49/74).29.7％的患者行血培养(22/74),阳性率为59.1％(13/22),其中草绿色链球菌占53.9％ (7/13).53例患者手术前诊断感染性心内膜炎,临床病理诊断符合率为71.7％(53/74).手术病死率为2.7％(2/74).结论先心病成为感染性心内膜炎的首要基础疾病,主动脉瓣二叶化畸形是最为常见的易合并感染性心内膜炎的先天畸形.患者血培养率和血培养阳性率低是本组病例的特点,但通过临床与病理诊断对比分析发现应用中国试行的诊断标准可提高感染性心内膜炎诊断阳性率.
목적 분석선천성심장병(선심병)합병감염성심내막염환자적발병특점,료해역발생감염성심내막염적선심병류형급림상진료정황.방법 수집1998지2009년부외심혈관병의원경외과수술절제、병이학학진적선심병합병감염성심내막염적병례,수집환자적상관림상자료.분석림상진단여병이학진단적부합솔급병이학표현여초성심동도검사적부합솔.결과 1998지2009년병이학진단선심병합병감염성심내막염74례,점동기소유외과교치감염성심내막염환자적33.6％(74/220).환자평균년령(32.8±13.8)세.재미교치선심병합병감염성심내막염환자중최상견적선심병류형위주동맥판이협화기형,점52.2％(35/67),환자년령(37.5±12.5)세,고우기타선심병합병감염성심내막염환자년령[(30.0±16.6)세,P=0.017].감염주요위우좌측방실판혹대동맥판(83.8％,62/74),주동맥판시수루최다적부위,기중단독수루47례(75.8％,47/62).74례환자균행경흉초성심동도검사,양성진단솔위66.3％(49/74).29.7％적환자행혈배양(22/74),양성솔위59.1％(13/22),기중초록색련구균점53.9％ (7/13).53례환자수술전진단감염성심내막염,림상병리진단부합솔위71.7％(53/74).수술병사솔위2.7％(2/74).결론 선심병성위감염성심내막염적수요기출질병,주동맥판이협화기형시최위상견적역합병감염성심내막염적선천기형.환자혈배양솔화혈배양양성솔저시본조병례적특점,단통과림상여병리진단대비분석발현응용중국시행적진단표준가제고감염성심내막염진단양성솔.
Objective To assess the changing profile of infective endocarditis (IE) in patients with congenital heart disease (CHD) from 1998 to 2009 in our hospital.Methods Clinical characteristics of IE patients with CHD underwent surgical treatment during 1998-2009 in our hospital were evaluated.The coincidence rate between clinical and pathological diagnosis were analyzed.Results There were 74 IE cases associated with CHD during the 12 years,accounting for 33.6％ of all patients with IE receiving surgery during this time period.Mean age was higher for patients treated in 2006-2009 than patients treated in 2002-2005 [(38.7 ± 14.6) years vs.(28.4 ± 12.8) years,P =0.003].Bicuspid aortic valve (accounting for 52.2％) was the most frequent congenital heart disease and the age of these patients was younger than patients with other congenital heart diseases.IE in CHD affected the left heart structures in 83.8％ (62/74) of all cases,47 in aortic valve (75.8％).Blood cultures were performed in 29.7％ of the patients(22/74) and the positive rate was 59.1％ (13/22).Streptococci viridans were the most common causative organisms.Echocardiography was performed in all patients and 66.3％ echocardiographic records were positive,IE was diagnosed in 53 patients (71.7％) before operation.The operative mortality was 2.7％.Conclusion Congenital heart disease,especially bicuspid aortic valve,is the most common underlying disease for IE.Combined analysis of clinical,echocardiographic and blood culture results are essential for increasing the diagnosis rate of IE.